Provider Demographics
NPI:1740270941
Name:MASCHINO, TAMMY RENEE (MD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:RENEE
Last Name:MASCHINO
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 1:2800 N KELLY AVE, STE 200
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3008
Mailing Address - Country:US
Mailing Address - Phone:405-726-8000
Mailing Address - Fax:405-726-8101
Practice Address - Street 1:2800 N KELLY AVE, STE 200
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3008
Practice Address - Country:US
Practice Address - Phone:405-726-8000
Practice Address - Fax:405-726-8101
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100125730BMedicaid
H68006Medicare UPIN