Provider Demographics
NPI:1447949995
Name:MCCALL, LOGAN ROBERT BASIL (MB,BCH,BAO)
Entity type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:ROBERT BASIL
Last Name:MCCALL
Suffix:
Gender:M
Credentials:MB,BCH,BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FAMILY MEDICINE CENTER
Mailing Address - Street 2:40 MEDICAL PARK, SUITE 401
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-3330
Mailing Address - Fax:304-243-3891
Practice Address - Street 1:FAMILY MEDICINE CENTER
Practice Address - Street 2:40 MEDICAL PARK, SUITE 401
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-3330
Practice Address - Fax:304-243-3891
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program