Provider Demographics
NPI:1902872203
Name:MOONEY, MARTHA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:L
Last Name:MOONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:12420 WARWICK BLVD STE 4C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3053
Practice Address - Country:US
Practice Address - Phone:757-596-7115
Practice Address - Fax:757-596-7127
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037180207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-032OtherTRICARE/CHAMPUS
VA145302OtherANTHEM
VA487727OtherUHC/MAMSI
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC890566NMedicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherCORVEL/CORCARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCIGNA
VA010108616Medicaid
NC0566NOtherBC/BS
VAPAROtherUSA MANAGED CARE
VAPAROtherAETNA
VA78596OtherSENTARA OPTIMA
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VA487727OtherUHC/MAMSI
VA006708E86Medicare PIN