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General NPI Number Information
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NPI Number | 1609871573
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Entity Type | Individual
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Provider Name | JONATHAN LOGAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 201 PARRISH ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1727
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Country | US
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Telephone | 585-394-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 201 PARRISH ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1727
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Country | US
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Telephone | 585-394-6070
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Fax | 585-394-3068
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 089645
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License Number State | NY
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