MEDICARE: DR. STEPHEN M MOONEY MD

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	36621	KY

General Provider Information

NPI Number	:	1003815622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN M MOONEY MD

Provider Business Mailing Address
First Line	:	2101 NICHOLASVILLE RD STE 304
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2526
Country	:	US
Telephone Number	:	859-277-5771
Fax Number	:	859-276-4622

Provider Business Practice Location Address
First Line	:	2101 NICHOLASVILLE RD STE 304
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2526
Country	:	US
Telephone Number	:	859-277-5771
Fax Number	:	859-276-4622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	12/04/2020

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