Provider Demographics
NPI:1114975760
Name:LOGES, RICHARD J III (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:LOGES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:965 WINDHAM CT STE 2
Mailing Address - Street 2:# 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5088
Mailing Address - Country:US
Mailing Address - Phone:330-629-9400
Mailing Address - Fax:330-629-9441
Practice Address - Street 1:965 WINDHAM CT STE 2
Practice Address - Street 2:# 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-629-9400
Practice Address - Fax:330-629-9441
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0704432085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293865Medicaid
OH0293865Medicaid
OHLO0814972Medicare PIN