Provider Demographics
NPI:1649490731
Name:LOGAN HEMATOLOGY-ONCOLOGY INC
Entity type:Organization
Organization Name:LOGAN HEMATOLOGY-ONCOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAFIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-792-1116
Mailing Address - Street 1:PO BOX 58176
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25358-0176
Mailing Address - Country:US
Mailing Address - Phone:304-792-1116
Mailing Address - Fax:304-792-1133
Practice Address - Street 1:77 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3451
Practice Address - Country:US
Practice Address - Phone:304-792-1116
Practice Address - Fax:304-792-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20171207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1801195001Medicaid
WVG50756Medicare UPIN
WV9328351Medicare ID - Type Unspecified