Logan, Jonathan Roy

Logan, Jonathan Roy is an individual health care provider with primary practice located at 1325 Locust Ave , Fairmont WV 26554-1435. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Logan, Jonathan Roy can be contacted via phone (304) 367-7100.

Contact Information

Primary practice address
1325 Locust Ave Fairmont WV 26554-1435
Phone: (304) 367-7100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 0101243177 Virginia
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 20682 West Virginia

Profile Details

NPI number 1629018387
LBN Legal business name Logan, Jonathan Roy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2006
Last updated Nov 17th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629018387 NPPES
West Virginia MEDICAID 1000450-000

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