Healthcare Provider Details

I. General information

NPI: 1073614897
Provider Name (Legal Business Name): MEGAN E RELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

40 DUKE MEDICINE CIR
DURHAM NC
27710-4000
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5077
  • Fax:
Mailing address:
  • Phone: 919-684-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number222555
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number9701855
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: