Healthcare Provider Details

I. General information

NPI: 1992265532
Provider Name (Legal Business Name): MEGAN ELIZABETH KENNELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ERWIN RD
DURHAM NC
27705-4504
US

IV. Provider business mailing address

3000 ERWIN RD
DURHAM NC
27705-4504
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-6669
  • Fax:
Mailing address:
  • Phone: 919-684-3104
  • Fax: 919-681-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number2025-01638
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2025-01638
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: