Provider Demographics
NPI:1932248564
Name:LOGSETTY, GIRIDHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:GIRIDHAR
Middle Name:
Last Name:LOGSETTY
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 1:2475 BLOOR ST WEST
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M6S 1P7
Mailing Address - Country:CA
Mailing Address - Phone:647-352-7445
Mailing Address - Fax:
Practice Address - Street 1:2475 BLOOR ST WEST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:CA / ONTARIO
Practice Address - Zip Code:M6S 1P7
Practice Address - Country:CA
Practice Address - Phone:647-352-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208158207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease