Provider Demographics
NPI:1184666018
Name:KELLY, MEGAN (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34936
Mailing Address - Street 2:DEPT # 5006
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1936
Mailing Address - Country:US
Mailing Address - Phone:206-439-2988
Mailing Address - Fax:206-431-3939
Practice Address - Street 1:16122 8TH AVE SW
Practice Address - Street 2:SUITE E-5
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2967
Practice Address - Country:US
Practice Address - Phone:206-241-0824
Practice Address - Fax:206-243-8002
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00035361207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG68843Medicare UPIN