Provider Demographics
NPI:1871577080
Name:LOGRANO, PAUL LOUIS
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LOUIS
Last Name:LOGRANO
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 1:118 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2120
Mailing Address - Country:US
Mailing Address - Phone:631-473-7171
Mailing Address - Fax:631-473-4605
Practice Address - Street 1:118 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2120
Practice Address - Country:US
Practice Address - Phone:631-473-7171
Practice Address - Fax:631-473-4605
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221522207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H46048Medicare UPIN
NY476D91Medicare PIN
NY476D91Medicare ID - Type Unspecified