Provider Demographics
NPI:1407875743
Name:ROONEY, ORLA MARY (DPM)
Entity Type:Individual
Prefix:
First Name:ORLA
Middle Name:MARY
Last Name:ROONEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N EAGLE CREEK DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-258-5900
Mailing Address - Fax:859-258-5905
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 440
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-258-5900
Practice Address - Fax:859-258-5905
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00267213E00000X, 213ES0103X
KY243989213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY36000818OtherMEDICAID ASC GROUP
KY80000086Medicaid
KYASC1019OtherMEDICARE ASC GROUP
KYCB5773OtherRR MEDICARE GROUP
KYP00186649OtherRR MEDICARE PIN
KY37903705OtherMEDICAID LAB GROUP
KY4000501OtherMEDICARE LAB GROUP
KY0455510001Medicare NSC
KY4000501OtherMEDICARE LAB GROUP
KYCB5773OtherRR MEDICARE GROUP
KY0945201Medicare ID - Type Unspecified