MEDICARE: JULIA ROSE LOGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	LP05633	RI
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	335909	NY

General Provider Information

NPI Number	:	1629727052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA ROSE LOGAN MD

Provider Business Mailing Address
First Line	:	1 EMBARCADERO CTR STE 1900
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-3723
Country	:	US
Telephone Number	:	415-658-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 W 81ST ST FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5728
Country	:	US
Telephone Number	:	212-321-7001
Fax Number	:	415-252-7176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	07/29/2025

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Directions to “ JULIA ROSE LOGAN MD” Practice Location

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