| Organization Name: | MARK E LOGAN MD PC |
| NPI Number: | 1003117078 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK E LOGAN (OWNER) |
| Mailing Address: | 199 Stratton Rd Rutland |
| State: | VT US |
| Postal Code: | 057014621 |
| Phone Number: | 8027757798 |
| Fax Number: | 8027757762 |
| NPI Enumeration Date: | 11/08/2010 |
| NPI Last Update Date: | 01/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RA0401X |
| License Number: | 042-0006819 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |