Provider Demographics
NPI:1164046942
Name:BARNES, LOGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SCOTCH RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-1300
Mailing Address - Country:US
Mailing Address - Phone:609-924-8532
Mailing Address - Fax:609-924-8532
Practice Address - Street 1:340 SCOTCH RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-1300
Practice Address - Country:US
Practice Address - Phone:609-924-8532
Practice Address - Fax:609-924-8532
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00827100363A00000X
IL085009161363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant