Individual
MICHAEL MOONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
60 FENWOOD RD, BOSTON, MA 02115-6128
(248) 933-0570
(602) 294-8286
Mailing address
60 FENWOOD RD, BOSTON, MA 02115-6128
(248) 933-0570
(602) 294-8286
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
281414
MA
207T00000X
Neurological Surgery Physician
Primary
284117
MA
207T00000X
Neurological Surgery Physician
MCS004591A
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R74142
AZ TRAINING PERMIT
AZ
Enumeration date
06/24/2013
Last updated
09/21/2020
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