Provider Demographics
NPI:1174581029
Name:LOGUE, MARCINE (NP)
Entity type:Individual
Prefix:
First Name:MARCINE
Middle Name:
Last Name:LOGUE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:330 MT AUBURN ST
Mailing Address - Street 2:PARSONS 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5597
Mailing Address - Country:US
Mailing Address - Phone:617-926-9000
Mailing Address - Fax:617-926-7053
Practice Address - Street 1:480 PLEASANT ST STE A300
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2463
Practice Address - Country:US
Practice Address - Phone:617-926-9000
Practice Address - Fax:617-926-7053
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2025-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN196221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110014310AMedicaid
MA0327964Medicaid
MAP24165Medicare UPIN