Provider Demographics
NPI:1710538525
Name:LOGAN, ANGELA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:LOGAN
Suffix:
Gender:F
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 1:4651 DOVERDELL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-1866
Mailing Address - Country:US
Mailing Address - Phone:412-260-6838
Mailing Address - Fax:
Practice Address - Street 1:695 CLAIRTON BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILLS
Practice Address - State:PA
Practice Address - Zip Code:15236-3811
Practice Address - Country:US
Practice Address - Phone:412-653-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant