Mary Lynn Moran, M.D.
Individual provider Active NPI Facial Plastic Surgery Physician · Woodside, CA
NPI 1417034877 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1417034877
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Facial Plastic Surgery Physician 207YS0123X
- License
- G-076828 (CA)
- Practice address
- 2973 Woodside Rd
Woodside, CA 94062-2443 - Phone
- (650) 851-0565
- Fax
- (650) 851-0520
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G-076828 | CA | MD | Facial Plastic Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Facial Plastic Surgery Physician | 207YS0123X | G-076828 | CA | Yes |
Addresses
Primary practice location
2973 Woodside Rd
Woodside, CA 94062-2443
Mailing address
600A Frazier Dr Ste 120
Franklin, TN 37067-4670
Phone (615) 224-8387
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G768280 | Medicaid | CA |
Other providers in Woodside, CA
- Saira Kothari
- Justine Labatch
- Richard Allen Lenon Jr.
- Vandana Mathur
- Michael a Mellenthin MD PC
- Maia Alexandra Mosse
- Courtney Lockwood Murphy
- National Center for Equine Facilitated Therapy
- Navvisa, Inc.
- Lisa Renae Nelson
All providers in Woodside, CA · Facial Plastic Surgery Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.