Provider Demographics
NPI:1467460352
Name:MOONEY, MAUREEN A (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:MOONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1703 S MERIDIAN
Mailing Address - Street 2:STE 101
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7590
Mailing Address - Country:US
Mailing Address - Phone:253-848-3000
Mailing Address - Fax:253-840-6514
Practice Address - Street 1:5225 CIRQUE DR W STE 200
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3639
Practice Address - Country:US
Practice Address - Phone:253-848-3000
Practice Address - Fax:253-845-8750
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00038710207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8254666Medicaid
WAAB15930Medicare ID - Type Unspecified
WA8254666Medicaid