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Contact Information

THEODORE P LOGAN, MD
12 UNION ST
ROCKLAND, ME04841-2739
 Phone: 207-701-4400
 Fax: 207-701-4487
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Addiction Medicine

2084A0401X 79 Physician/Addiction Medicine
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for THEODORE P LOGAN · (Male)

NPI Number 1427054873
Status Active
Credentials MD
Entity Individual
Enumeration date 06/21/2005
Last updated 03/21/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • ME License # 012617
  • ME License # MD12617
  • ME Medicaid 255750099
  • ME Other 047853 ANTHEM STAR NUMBER
Hospital affiliation(s)
  • PENOBSCOT BAY MEDICAL CENTER - (Acute Care)
    6 GLEN COVE DRIVE
    ROCKPORT, ME 04856
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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