Basic Information
| Provider Information | |||||||||
| NPI: | 1093120966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOGAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 MACK BLVD FL 4 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181035622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840628 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 S CEDAR CREST BLVD STE 2700 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104023866 | ||||||||
| FaxNumber: | 6104023859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD461707 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | TRN20430 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0214X | MD461707 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
No ID Information.