Casey Douglas Logan, MD | |
2790 Mosside Blvd Ste 720, Monroeville, PA 15146-2757 | |
(412) 372-2770 | |
(412) 372-4656 |
Full Name | Casey Douglas Logan |
---|---|
Gender | Male |
Speciality | Dermatology |
Location | 2790 Mosside Blvd Ste 720, Monroeville, Pennsylvania |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1245727692 | NPI | - | NPPES |
1040784250001 | Medicaid | PA | |
1040784250002 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207N00000X | Dermatology | MD479164 (Pennsylvania) | Primary |
Entity Name | Forefront Dermatology Sc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1720443211 PECOS PAC ID: 3779471701 Enrollment ID: O20160209002503 |
Mailing Address | Practice Location Address |
---|---|
Casey Douglas Logan, MD 801 York St, Manitowoc, WI 54220-4630 Ph: (920) 663-9008 | Casey Douglas Logan, MD 2790 Mosside Blvd Ste 720, Monroeville, PA 15146-2757 Ph: (412) 372-2770 |
Dr. Joseph John Stuckert Ii, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3824 Northern Pike, Ste 900, Monroeville, PA 15146 Phone: 412-457-0422 Fax: 412-457-1180 | |
Dr. Ezra David Mirvish, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 2790 Mosside Blvd Ste 720, Monroeville, PA 15146 Phone: 412-372-2770 Fax: 412-372-4656 | |
Lisa A Goldberg, MD Dermatology Medicare: Not Enrolled in Medicare Practice Location: 2790 Mosside Blvd Ste 720, Monroeville, PA 15146 Phone: 412-372-2770 Fax: 412-372-4656 | |
Jeffrey G Weaver, DO Dermatology Medicare: Accepting Medicare Assignments Practice Location: 2790 Mosside Blvd, Suite 105, Monroeville, PA 15146 Phone: 412-372-2277 Fax: 412-373-2307 | |
Andrew Hankinson, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 2790 Mosside Blvd Ste 720, Monroeville, PA 15146 Phone: 412-372-2770 Fax: 412-372-4656 | |
Carol K Roper, MD Dermatology Medicare: Not Enrolled in Medicare Practice Location: 2790 Mosside Blvd, Ste 105, Monroeville, PA 15146 Phone: 412-372-2277 Fax: 412-373-2307 |