Provider Demographics
NPI:1134118029
Name:LOGRASSO, PAUL P (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:P
Last Name:LOGRASSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2038
Mailing Address - Country:US
Mailing Address - Phone:609-261-7095
Mailing Address - Fax:609-261-3751
Practice Address - Street 1:175 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2038
Practice Address - Country:US
Practice Address - Phone:609-261-7095
Practice Address - Fax:609-261-3751
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB004496100207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0060241Medicaid
E28059Medicare UPIN