Healthcare Provider Details

I. General information

NPI: 1073360962
Provider Name (Legal Business Name): MOONEY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 WALES AVE NW STE 220
MASSILLON OH
44646-2398
US

IV. Provider business mailing address

2520 WALES AVE NW STE 220
MASSILLON OH
44646-2398
US

V. Phone/Fax

Practice location:
  • Phone: 330-778-8778
  • Fax: 330-944-0169
Mailing address:
  • Phone: 330-576-5761
  • Fax: 330-974-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN BRECK MOONEY
Title or Position: STAFF PHYSICIAN
Credential: MD
Phone: 330-440-0323