Healthcare Provider Details

I. General information

NPI: 1215867668
Provider Name (Legal Business Name): MEGAN ELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 MACCORKLE AVE SE
CHARLESTON WV
25304-1334
US

IV. Provider business mailing address

3415 MACCORKLE AVE SE
CHARLESTON WV
25304-1334
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-2476
  • Fax:
Mailing address:
  • Phone: 304-388-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number126708
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: