Provider Demographics
NPI:1447241377
Name:LOGUE, ANDREW DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DOUGLAS
Last Name:LOGUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:DOUGLAS
Other - Last Name:LOGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:159 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3442
Mailing Address - Country:US
Mailing Address - Phone:609-921-1243
Mailing Address - Fax:609-921-8408
Practice Address - Street 1:20 NASSAU ST
Practice Address - Street 2:SUITE 513
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4509
Practice Address - Country:US
Practice Address - Phone:609-683-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA490902084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6150209Medicaid