Provider Demographics
NPI:1407967953
Name:WARD, JOHN LOGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LOGAN
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 QUININE HL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-3414
Mailing Address - Country:US
Mailing Address - Phone:803-782-2377
Mailing Address - Fax:803-782-8003
Practice Address - Street 1:30 QUININE HL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-3414
Practice Address - Country:US
Practice Address - Phone:803-782-2377
Practice Address - Fax:803-782-8003
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4596207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF20681Medicare UPIN