Provider Demographics
NPI:1003815622
Name:MOONEY, STEPHEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:MOONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NICHOLASVILLE RD STE 304
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2526
Mailing Address - Country:US
Mailing Address - Phone:859-277-5771
Mailing Address - Fax:859-276-4622
Practice Address - Street 1:2101 NICHOLASVILLE RD STE 304
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2526
Practice Address - Country:US
Practice Address - Phone:859-277-5771
Practice Address - Fax:859-276-4622
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1099204Medicare ID - Type Unspecified
H37386Medicare UPIN