Provider Demographics
NPI:1396858544
Name:FEARNEYHOUGH, PAUL K (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:K
Last Name:FEARNEYHOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1941 BISHOP LN STE 1018
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1928
Mailing Address - Country:US
Mailing Address - Phone:502-456-6217
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:839 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2209
Practice Address - Country:US
Practice Address - Phone:502-456-6217
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26777207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY096604OtherHEALTH ALLIANCE
KY114362OtherAETNA BETTER HEALTH
690009345OtherRAILROAD MEDICARE
KY300047661101OtherHUMANA CARESOURCE
KY50115666OtherPASSPORT
KY5115678OtherAETNA
KY000000247638OtherANTHEM BLUE CROSS BS
TN4046474Medicaid
KY478847OtherHEALTHLINK
1194542OtherCHA
IN200375370AMedicaid
VA277243OtherANTHEM MC SUPP
8642798OtherCIGNA
KY64048473Medicaid
KY03-00255OtherUNITED HEALTHCARE
IL300047661-40217-01Medicaid
NH3103052Medicaid
KY600493OtherWELLCARE MA
1194542OtherCHA
KY4015801Medicare PIN