MEDICARE: DR. MARY LYNN MORAN M.D.

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	207YS0123X	Facial Plastic Surgery Physician	G-076828	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417034877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY LYNN MORAN M.D.

Provider Business Mailing Address
First Line	:	600A FRAZIER DR STE 120
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-4670
Country	:	US
Telephone Number	:	615-224-8387
Fax Number	:

Provider Business Practice Location Address
First Line	:	2973 WOODSIDE RD
Second Line	:
City	:	WOODSIDE
State	:	CA
Zip	:	94062-2443
Country	:	US
Telephone Number	:	650-851-0565
Fax Number	:	650-851-0520

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/11/2025

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