Basic Information
| Provider Information | |||||||||
| NPI: | 1912096421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOGAN | ||||||||
| FirstName: | CLARE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 VICTORY PKWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453052 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY FAMILY PHYSICIANS INC | ||||||||
| Address2: | 141 HEALTH PROFESSIONS BUILDING | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452670001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135584021 | ||||||||
| FaxNumber: | 5135583030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/25/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50.000435 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 50.000435 | 01 | OH | STATE PA REGISTRATION NUM | OTHER | NCCPA 890815 | 01 | NATIONAL PA CERTIFICATION | OTHER |