Healthcare Provider Details

I. General information

NPI: 1801233390
Provider Name (Legal Business Name): COURTNEY LYNN TIGHE MOYNIHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 07/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 STEELECROFT PKWY STE 240
CHARLOTTE NC
28278-7565
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-512-3860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2017-01060
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: