Provider Demographics
NPI:1669464566
Name:MASCOTTI, KRISTIN M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:MASCOTTI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:CHILDREN'S HEALTH CARE
Mailing Address - Street 2:2910 CENTRE POINTE DRIVE 35-121A
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2109
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:CHILDREN'S HOSPITALS AND CLINICS PATHOLOGY MPLS
Practice Address - Street 2:2525 CHICAGO AVENUE SOUTH
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-813-6280
Practice Address - Fax:612-813-6951
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2014-09-02
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Provider Licenses
StateLicense IDTaxonomies
MN41507207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN312523800Medicaid
F95995Medicare UPIN