Provider Demographics
NPI:1710025887
Name:COBB, MAHONEY E (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHONEY
Middle Name:E
Last Name:COBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE G71
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-456-6212
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:4000 KRESGE WAY STE P1503
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-456-6212
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37310207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000548820OtherANTHEM
KY029044500OtherBLACK LUNG
KY1301279OtherUMWA
KY7100030490Medicaid
KYP00713837OtherMEDICARE RR
KY3527415000OtherPASSPORT ADVANTAGE
KY50018022OtherPASSPORT
KY11-00338OtherUHC
IN200896910AMedicaid
IN200896910AMedicaid