Provider Demographics
NPI:1114427234
Name:LOGUE, JOHN (CPO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:LOGUE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3530
Mailing Address - Country:US
Mailing Address - Phone:443-487-4394
Mailing Address - Fax:240-482-8839
Practice Address - Street 1:4000 OLD COURT RD STE 105A
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:443-487-4394
Practice Address - Fax:240-482-8839
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist