Provider Demographics
NPI:1073360962
Name:MOONEY MD LLC
Entity type:Organization
Organization Name:MOONEY MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BRECK
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-440-0323
Mailing Address - Street 1:2520 WALES AVE NW STE 220
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2398
Mailing Address - Country:US
Mailing Address - Phone:330-576-5761
Mailing Address - Fax:330-974-1617
Practice Address - Street 1:2520 WALES AVE NW STE 220
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2398
Practice Address - Country:US
Practice Address - Phone:330-778-8778
Practice Address - Fax:330-944-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty