Individual
MARY L IRELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2195 HARRODSBURG RD STE 125, LEXINGTON, KY 40504-3543
(859) 218-3064
(859) 257-8696
Mailing address
601 PERIMETER DR, SUITE 200, LEXINGTON, KY 40517-4121
(859) 268-0268
(859) 268-4519
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
24323
KY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
24323
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000048615
ANTHEM BCBS
KY
01
—
25001766
RAILROAD MEDICARE
KY
01
—
4341027
AETNA
KY
05
—
65939795
—
KY
Enumeration date
07/27/2006
Last updated
01/29/2024
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