Provider Demographics
NPI:1992765200
Name:LOGAN, KENT A (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:A
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:55 HIGH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2213
Mailing Address - Country:US
Mailing Address - Phone:603-601-7762
Mailing Address - Fax:603-601-6040
Practice Address - Street 1:55 HIGH ST STE 301
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2213
Practice Address - Country:US
Practice Address - Phone:603-601-7762
Practice Address - Fax:603-601-6040
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH111982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076239Medicaid
NH3076239Medicaid
NHRE611201Medicare PIN