Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD461707 | PA |
N | 208000000X | Pediatrician | TRN20430 | FL |
Y | 2080P0214X | Pediatric Pulmonologist | MD461707 | PA |
NPI | 1093120966 |
---|---|
Provider Name | Jennifer B Logan |
First Address | Allentown, PA 18103-5622 |
Second Address | Allentown, PA 18103-6239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 17/08/2021 |