Provider Demographics
NPI:1801962253
Name:LOGAN, JOCELYN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:MARIE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOCELYN
Other - Middle Name:MARIE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7895 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-947-1910
Mailing Address - Fax:219-947-3117
Practice Address - Street 1:7895 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6665
Practice Address - Country:US
Practice Address - Phone:219-947-1910
Practice Address - Fax:219-947-3117
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078708A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3087001Medicaid
IN201002790Medicaid
KY7100124610Medicaid
OHH042530Medicare PIN