Provider Demographics
NPI:1093795965
Name:LOGAN, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3770
Mailing Address - Country:US
Mailing Address - Phone:412-267-6600
Mailing Address - Fax:412-267-6281
Practice Address - Street 1:575 COAL VALLEY RD STE 300
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3770
Practice Address - Country:US
Practice Address - Phone:412-267-6600
Practice Address - Fax:412-267-6281
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064254L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001689069Medicaid
PA001689069Medicaid
PA006787Medicare PIN
PACG1496Medicare PIN
PAG70120Medicare UPIN