Provider Demographics
NPI:1427045053
Name:MUSCATO, MARY S (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:MUSCATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5852
Mailing Address - Country:US
Mailing Address - Phone:573-874-7800
Mailing Address - Fax:573-443-3627
Practice Address - Street 1:1705 E BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5852
Practice Address - Country:US
Practice Address - Phone:573-874-7800
Practice Address - Fax:573-443-3627
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7B63207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A13424OtherMERCY HEALTH PLANS
106097OtherBCBS OF MO
5132415OtherAETNA
65201A006OtherTRICARE
27355OtherGHP
118061OtherHEALTHLINK
MO201595618Medicaid
3000018OtherUNITED HEALTHCARE
A13424OtherMERCY HEALTH PLANS
5132415OtherAETNA
MO201595618Medicaid
27355OtherGHP