MEDICARE: KENLY MEDICAL ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0155K	OTHER		BC

General Provider Information

NPI Number	:	1518075712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENLY MEDICAL ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	101 E 2ND STREET
Second Line	:
City	:	KENLY
State	:	NC
Zip	:	27542-0275
Country	:	US
Telephone Number	:	919-284-4025
Fax Number	:	919-284-5965

Provider Business Practice Location Address
First Line	:	101 EAST SECOND STREET
Second Line	:
City	:	KENLY
State	:	NC
Zip	:	27542-0275
Country	:	US
Telephone Number	:	919-284-4025
Fax Number	:	919-284-5965

Authorized Official
Title or Position	:	OWNER
Name	:	HAL B WOODALL
Credential	:	MD
Telephone Number	:	919-284-4025

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	05/05/2015

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Directions to “KENLY MEDICAL ASSOCIATES, PA ” Practice Location

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