Provider Demographics
NPI:1447541586
Name:KENALEY, KAITLIN M (MD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:M
Last Name:KENALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MEGAN
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 HYGEIA DRIVE
Mailing Address - Street 2:CCHS PHYSICIAN CONTRACTING, SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4745 OGLETOWN STANTON ROAD
Practice Address - Street 2:MAP 1, SUITE 217
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2074
Practice Address - Country:US
Practice Address - Phone:302-733-4387
Practice Address - Fax:302-733-4252
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0012087208000000X
390200000X
DEC1.00120872080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program