Provider Demographics
NPI:1750358305
Name:MOONEY, RICHARD LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEROY
Last Name:MOONEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:
Practice Address - Street 1:221 3RD ST W
Practice Address - Street 2:
Practice Address - City:RANDOLPH A F B
Practice Address - State:TX
Practice Address - Zip Code:78150-4800
Practice Address - Country:US
Practice Address - Phone:210-652-8544
Practice Address - Fax:210-652-9836
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2018-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine