Mark E Logan MD PC

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

042-0006819 Issued in VT

Legal business name

MARK E LOGAN MD PC

Doing business as

Green Mountain Family Medicine

Practice address

199 Stratton Rd
Rutland, VT 05701-4621

Phone

(802) 775-7798

Fax

(802) 775-7762

NPI assigned

Nov 8, 2010

Last updated

Jan 12, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark E Logan, MDNPI 1184679227

Title

Owner

Phone

(802) 775-7798

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Green Mountain Family Medicine Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark Edward Logan, MD

  • Internal Medicine Physician
  • Rutland, VT
  • NPI 1184679227
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421020800000",
    "number": "1003117078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 STRATTON RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014621",
            "telephone_number": "802-775-7798",
            "fax_number": "802-775-7762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 STRATTON RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014621",
            "telephone_number": "802-775-7798",
            "fax_number": "802-775-7762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK E LOGAN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-08",
        "last_updated": "2015-01-12",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-775-7798",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "VT",
            "license": "042-0006819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018281",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Mountain Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eric James Marsh, MD

• Addiction Medicine (Internal Medicine) Physician in Rutland, VT
• Providers in Rutland, VT by specialty
• Addiction Medicine (Internal Medicine) Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.