Active NPI
Mary Bernadette Kenny Moynihan, MD
- Anatomic Pathology & Clinical Pathology Physician
- Lakewood, CO
National Provider Identifier
1760479042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 34459
- Practice address
- 7444 W Alaska Dr
Ste 250
Lakewood, CO 80226-3327 - Phone
- (303) 592-7284
- Fax
- (303) 892-0601
- NPI assigned
- Oct 3, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 34459 | CO | Primary |
Addresses
Primary practice location
7444 W Alaska Dr
Ste 250
Lakewood, CO 80226-3327
Mailing address
7444 W Alaska Dr
Ste 250
Lakewood, CO 80226-3327
Phone (303) 592-7284
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 94287091 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34459 | CO | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195516800000",
"number": "1760479042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7444 W ALASKA DR",
"address_2": "STE 250",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802263327",
"telephone_number": "303-592-7284",
"fax_number": "303-892-0601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7444 W ALASKA DR",
"address_2": "STE 250",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802263327",
"telephone_number": "303-592-7284",
"fax_number": "303-892-0601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNY MOYNIHAN",
"first_name": "MARY",
"middle_name": "BERNADETTE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-03",
"last_updated": "2007-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "CO",
"license": "34459",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "94287091",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.