Provider Demographics
NPI:1619001633
Name:MCDANELD, LOGAN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:MATTHEW
Last Name:MCDANELD
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 1:2635 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8209
Mailing Address - Country:US
Mailing Address - Phone:970-298-2273
Mailing Address - Fax:970-298-1809
Practice Address - Street 1:750 WELLINGTON AVE
Practice Address - Street 2:STE 3C
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6132
Practice Address - Country:US
Practice Address - Phone:970-298-3150
Practice Address - Fax:970-298-3151
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL159942084N0400X
CODR.00504202084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA3585Medicare PIN