Healthcare Provider Details

I. General information

NPI: 1750337903
Provider Name (Legal Business Name): KATHLEEN ANNE MCGANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ERWIN RD
DURHAM NC
27710-0001
US

IV. Provider business mailing address

4101 N ROXBORO ST
DURHAM NC
27704-2121
US

V. Phone/Fax

Practice location:
  • Phone: 919-620-4918
  • Fax: 919-620-4921
Mailing address:
  • Phone: 919-620-4918
  • Fax: 919-620-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0090-00736
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: