Rodney D Logan, MD
Individual provider Active NPI Family Medicine Physician · Perry, NY
NPI 1811989015 · NPPES record last updated Oct 26, 2011
Key facts
- NPI
- 1811989015
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 146686 (NY)
- Practice address
- 3 Handley St
Perry, NY 14530-1342 - Phone
- (585) 237-3227
- Fax
- (585) 237-6075
- NPI assigned
- Aug 16, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146686 | NY | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 146686 | NY | Yes |
Addresses
Primary practice location
3 Handley St
Perry, NY 14530-1342
Mailing address
3 Handley St
Perry, NY 14530-1342
Phone (585) 237-3227
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00604140 | Medicaid | NY |
Other providers in Perry, NY
- Terri Adair Humberstone
- Kevin Michael Hyland
- Brittni Kwiecien
- Letchworth Family Medicine PC
- David Allen Lewandowski
- Alyssa C Meyer
- Deborah Jean Mix
- J Gage Moran
- Jane Elizabeth Muck
- Stacee J Muolo
All providers in Perry, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.