Healthcare Provider Details
I. General information
NPI: 1194016444
Provider Name (Legal Business Name): MEGAN S MCHENRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 04/20/2011
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
705 RILEY HOSPITAL DR RI 3004
INDIANAPOLIS IN
46202-5109
US
IV. Provider business mailing address
PO BOX 1026
INDIANAPOLIS IN
46206-1026
US
V. Phone/Fax
- Phone: 317-948-2700
- Fax: 317-948-2959
- Phone: 317-777-6435
- Fax: 317-777-6644
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 01073359A |
| License Number State | IN |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: