| Dr Mark Edward Logan, MD | |
| 199 Stratton Rd, Rutland, VT 05701-4621 | |
| (802) 775-7798 | |
| Not Available | 
| Full Name | Dr Mark Edward Logan | 
|---|---|
| Gender | Male | 
| Speciality | Internal Medicine | 
| Location | 199 Stratton Rd, Rutland, Vermont | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1184679227 | NPI | - | NPPES | 
| 61-1488339 | Other | VT | TAX ID | 
| 0005483 | Medicaid | VT | |
| 042-0006819 | Other | VT | LICENSE | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207R00000X | Internal Medicine | 042-0006819 (Vermont) | Primary | 
| Entity Name | Connecticut Valley Addiction Recovery Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1750932646 PECOS PAC ID: 1850710179 Enrollment ID: O20201006000289 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Dr Mark Edward Logan, MD 199 Stratton Rd, Rutland, VT 05701-4621 Ph: (802) 775-7798 | Dr Mark Edward Logan, MD 199 Stratton Rd, Rutland, VT 05701-4621 Ph: (802) 775-7798 | 
| Michael William Gleeson, MD, PHD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 1 Albert Cree Dr, Rutland, VT 05701 Phone: 802-786-1400 Fax: 802-786-1405 | |
| Sudhir Babu Movva, M.D Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 160 Allen St, Rutland, VT 05701 Phone: 802-747-1633 Fax: 802-775-7214 | |
| T Ray Lovko, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 215 Stratton Rd, Rutland, VT 05701 Phone: 802-773-3386 Fax: 802-773-4578 | |
| Dr. Louis Block Meyers, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 160 Allen St, Rutland, VT 05701 Phone: 802-775-7111 Fax: 802-772-2556 | |
| Mark C Stickney, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 3 Commons St, Rutland, VT 05701 Phone: 802-773-7155 Fax: 802-773-7616 | |
| Darius Seidler, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 160 Allen St, Rutland, VT 05701 Phone: 802-775-7111 Fax: 802-747-6207 |