Provider Demographics
NPI:1447595608
Name:GRADY, MEGAN MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MICHELLE
Last Name:GRADY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2511 OLD CORNWALLIS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1869
Mailing Address - Country:US
Mailing Address - Phone:919-932-5700
Mailing Address - Fax:919-933-6881
Practice Address - Street 1:2511 OLD CORNWALLIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1869
Practice Address - Country:US
Practice Address - Phone:919-932-5700
Practice Address - Fax:919-933-6881
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2022-01-17
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Provider Licenses
StateLicense IDTaxonomies
NC0010-3929207R00000X
NC0010-03929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-03929OtherLICENSE