Provider Demographics
NPI:1932365665
Name:HASTINGS, MARY VATTEROTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:VATTEROTT
Last Name:HASTINGS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1402 S. GRAND
Mailing Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-977-8492
Mailing Address - Fax:314-977-5268
Practice Address - Street 1:6121 N HANLEY RD
Practice Address - Street 2:ST LOUIS COUNTY DEPARTMENT OF HEALTH
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-2003
Practice Address - Country:US
Practice Address - Phone:314-615-5767
Practice Address - Fax:314-615-5629
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2013-09-19
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Provider Licenses
StateLicense IDTaxonomies
MOR8E99207Q00000X
MOMOR8399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO289050157OtherCPIN
MOC51173Medicare UPIN