Provider Demographics
NPI:1861475261
Name:MASCHING, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MASCHING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SUNSET HILLS DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3633
Mailing Address - Country:US
Mailing Address - Phone:618-655-1422
Mailing Address - Fax:618-655-1423
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:618-463-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092388207Q00000X
IL036-092388207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092388Medicaid
IL036092388-1Medicaid
MO204900609Medicaid
ILL75322Medicare PIN
ILG88793Medicare UPIN
IL036092388Medicaid
ILIL1682003Medicare PIN
MO204900609Medicaid