Mitchell Logan Grant Logan
Student in an Organized Health Care Education/Training Program in New Haven, CT. Individual provider (NPI-1).
Details
- NPI
- 1134065014
- Entity type
- Individual (NPI-1)
- Name
- Mitchell Logan Grant Logan
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 24, 2026
- Certification date
- Apr 24, 2026
- Last updated
- Apr 24, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - DENTIST
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
20 York StNew Haven, CT 06510-3220
Phone 203-688-4242
Mailing address
20 York StNew Haven, CT 06510-3220
Phone 203-688-4242
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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