Provider Demographics
NPI:1912096421
Name:LOGAN, CLARE M (PA-C)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:M
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 1:2830 VICTORY PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1786
Mailing Address - Country:US
Mailing Address - Phone:513-245-3052
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY FAMILY PHYSICIANS INC
Practice Address - Street 2:141 HEALTH PROFESSIONS BUILDING
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0001
Practice Address - Country:US
Practice Address - Phone:513-558-4021
Practice Address - Fax:513-558-3030
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000435363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.000435OtherSTATE PA REGISTRATION NUM
NCCPA 890815OtherNATIONAL PA CERTIFICATION
OHLOPA12562Medicare PIN
OH50.000435OtherSTATE PA REGISTRATION NUM
OHP00415725Medicare PIN
OHLOPA12563Medicare PIN
NCCPA 890815OtherNATIONAL PA CERTIFICATION