Provider Demographics
NPI:1700619467
Name:DUFFY, LOGAN ROLLINS
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:ROLLINS
Last Name:DUFFY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 MATTHEWS LN
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-4036
Mailing Address - Country:US
Mailing Address - Phone:703-919-1913
Mailing Address - Fax:
Practice Address - Street 1:14955 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8700
Practice Address - Country:US
Practice Address - Phone:301-984-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program