=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730976341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOGAN CHARLES SHCHERBYNA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2025
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 SCHUYLKILL MEDICAL PLZ
-----------------------------------------------------
City | POTTSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17901-3660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-621-9270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 424 N BARRETT LN
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19702-2993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-626-9794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------