Provider Demographics
NPI:1184622912
Name:LOGEE, MARY JO (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JO
Last Name:LOGEE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3373 COMMERCE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7130
Mailing Address - Country:US
Mailing Address - Phone:330-804-9712
Mailing Address - Fax:330-804-9717
Practice Address - Street 1:3373 COMMERCE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7130
Practice Address - Country:US
Practice Address - Phone:330-804-9712
Practice Address - Fax:330-804-9717
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2009-02-12
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Provider Licenses
StateLicense IDTaxonomies
OH350610222083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0891512Medicaid
F34281Medicare UPIN
OH8626940001Medicare NSC
OH0891512Medicaid