Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 294431 | NY |
N | 111NI0900X | Internist | 294431 | NY |
Y | 207RI0200X | Infectious Disease | 294431 | NY |
NPI | 1013303007 |
---|---|
Provider Name | Logan Laurence Bartram |
First Address | New York, NY 10017-5699 |
Second Address | New York, NY 10029-5204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 06/07/2020 |