Healthcare Provider Details

I. General information

NPI: 1073757951
Provider Name (Legal Business Name): MEGAN HENNIGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 5018
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE ML 5018
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-9979
  • Fax: 513-636-0105
Mailing address:
  • Phone: 513-636-9979
  • Fax: 513-636-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.099951
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: