| Dr Jonathan Roy Logan, MD | |
|
1325 Locust Ave, Fairmont, WV 26554-1435 | |
| (304) 367-7100 | |
| Not Available |
| Full Name | Dr Jonathan Roy Logan |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 1325 Locust Ave, Fairmont, West Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629018387 | NPI | - | NPPES |
| 1000450-000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 0101243177 (Virginia) | Primary |
| 207P00000X | Emergency Medicine | 20682 (West Virginia) | Secondary |
| Entity Name | Emergency Physicians Of Southern Virginia Llp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1417187667 PECOS PAC ID: 0345236568 Enrollment ID: O20040422001520 |
| Entity Name | Emergency Coverage Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427005008 PECOS PAC ID: 3072412592 Enrollment ID: O20050418000414 |
| Entity Name | Ingleside Emergency Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1144712662 PECOS PAC ID: 1355698317 Enrollment ID: O20180720002968 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Jonathan Roy Logan, MD 6005 Wooland Bluffs Drive, Morgantown, WV 26508 Ph: () - | Dr Jonathan Roy Logan, MD 1325 Locust Ave, Fairmont, WV 26554-1435 Ph: (304) 367-7100 |
Amanda Puleo, DO Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 1325 Locust Ave, Fairmont, WV 26554 Phone: 304-534-7810 | |
Ronald Chevine Fleming, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1325 Locust Avenue, Fairmont, WV 26554 Phone: 304-367-7100 Fax: 304-799-2229 | |
Jennifer Shreves, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 140 Middletown Loop, Fairmont, WV 26554 Phone: 304-333-1150 Fax: 304-333-1169 | |
Dr. Matthew Francis Verona, D.O. Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 1325 Locust Ave, Fairmont, WV 26554 Phone: 304-367-7100 | |
Dr. Nathan C Berry, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 110 Meadowlane Ave, Fairmont, WV 26554 Phone: 256-443-4743 | |
Dr. Robert Clayton Thompson Jr., M.D. Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 238 Colfax Camp Rd, Fairmont, WV 26554 Phone: 304-216-3412 |