Healthcare Provider Details

I. General information

NPI: 1740573625
Provider Name (Legal Business Name): MEGAN KINNEY KAUFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 S COLLEGE RD
WILMINGTON NC
28412-2209
US

IV. Provider business mailing address

2421 SILVER STREAM LN
WILMINGTON NC
28401-7684
US

V. Phone/Fax

Practice location:
  • Phone: 910-341-3300
  • Fax: 910-251-2067
Mailing address:
  • Phone: 910-341-3300
  • Fax: 910-251-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number2014-01016
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number2014-01016
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2014-01016
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: