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NPI Code Detail

MEDICARE: MARY IRENE MOONEY

MEDICARE: MARY IRENE MOONEY
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1568301646
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY IRENE MOONEY
Provider Business Mailing Address
First Line : 1402 COUNTY ROAD 1475
Second Line :
City : ASHLAND
State : OH
Zip : 44805-9725
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3249 OAK PARK AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-3429
Country : US
Telephone Number : 567-215-7306
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2026
Last Update Date : 03/25/2026

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Directions to “ MARY IRENE MOONEY ” Practice Location

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