MARK E LOGAN MD PC (NPI# 1003117078) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003117078 |
| Entity Type | Organization |
| Organization Name | MARK E LOGAN MD PC |
| Other Organization Name | GREEN MOUNTAIN FAMILY MEDICINE |
| Practice Address |
199 Stratton Rd Rutland VT 05701-4621 |
| Practice Telephone | 8027757798 |
| Practice Fax Number | 8027757762 |
| Mailing Telephone | 8027757798 |
| Mailing Fax Number | 8027757762 |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2015-01-12 |
| Authorized Official Name | MARK E LOGAN (OWNER) |
| Authorized Official Telephone | 8027757798 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
042-0006819 | VT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VT | 1018281 | 05 |
| Other Name | Type Code |
|---|---|
| Green Mountain Family Medicine | Doing Business As Name - Organization |
| Street Address |
199 STRATTON RD |
| City | RUTLAND |
| State | VT |
| Zip Code | 05701-4621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184679227 | Mark Edward Logan | Internal Medicine | 199 Stratton Rd, Rutland, VT 05701-4621 | 2006-05-24 |
| 1851712657 | Green Mountain Family Medicine | Nurse Practitioner | 199 Stratton Rd, Rutland, VT 05701-4890 | 2013-12-20 |
| 1497187447 | Cynthia G Seager | Counselor | 199 Stratton Rd, Rutland, VT 05701-4890 | 2013-08-01 |
| 1558703561 | Suzanne Daley | Counselor | 199 Stratton Rd, Rutland, VT 05701-4890 | 2013-07-19 |
| 1639425903 | Advanced Laboratories, LLC | Clinical Medical Laboratory | 199 Stratton Rd, Rutland, VT 05701-4890 | 2012-07-24 |
| 1649536046 | Brooke Larmie | Nurse Practitioner | 199 Stratton Rd, Rutland, VT 05701-4890 | 2012-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639721186 | All Dimensions Primary Care Pllc | Physician Assistant | 92 Allen Street, Rutland, VT 05701 | 2019-07-15 |
| 1962809053 | Laura Kalinen Laprise | Nurse Practitioner | Rutland Community Health Center, 215 Stratton Road, Rutland, VT 05701 | 2014-12-04 |
| 1962818781 | Andrea Louise Welch | Pharmacist | 1 Rutland Shopping Plaza, Rutland, VT 05701 | 2014-07-02 |
| 1396158903 | Gwendolyn Koenig | Counselor | 78 South Main St., Rutland, VT 05701 | 2014-06-11 |
| 1194088195 | Marcie Bouchard | Early Intervention Provider Agency | 24a East Street, Rutland, VT 05701 | 2012-06-25 |
| 1790047009 | Pamela Lenoci | Massage Therapist | 196 Joshua Place, Rutland, VT 05701 | 2012-06-12 |
| 1528339959 | Deborah E. Boston | Social Worker | 128 Merchants Row Ste 510, Rutland, VT 05701 | 2012-01-17 |
| 1235431834 | Alicia Marie Riesterer | Occupational Therapy Assistant | 46 Nichols St., Rutland Healthcare and Rehabilitation Center, Rutland, VT 05701 | 2010-12-02 |
| 1497085401 | Lauren Ann Lasante | Counselor | 198 N Main St Ste C-5, Rutland, VT 05701 | 2010-01-14 |
| 1568692515 | Steven C. Duboff, Dmd, PC | Dentist | 198 North Main St, Rutland, VT 05701 | 2009-07-23 |
| Find all providers in zip 05701 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| 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. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447208269 | William Bradford Hoge Bissell | Internal Medicine | 160 Allen Street, Rutland Regional Medical Center, Rutland, VT 05701 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639381668 | Connecticut Valley Recovery Services, Inc. | Internal Medicine | 141 Etta Frasier Dr, Windsor, VT 05089-1315 | 2007-05-03 |
| 1750932646 | Connecticut Valley Addiction Recovery, Inc | Internal Medicine | 141 Etta Frasier Dr, Windsor, VT 05089-1315 | 2019-09-23 |
| 1497828859 | Clifton Frederick Lord | Internal Medicine | 15 State St, Windsor, VT 05089-1201 | 2006-11-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.