Healthcare Provider Details

I. General information

NPI: 1427045053
Provider Name (Legal Business Name): MARY S MUSCATO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E BROADWAY SUITE 100
COLUMBIA MO
65201-5852
US

IV. Provider business mailing address

1705 E BROADWAY SUITE 100
COLUMBIA MO
65201-5852
US

V. Phone/Fax

Practice location:
  • Phone: 573-874-7800
  • Fax: 573-443-3627
Mailing address:
  • Phone: 573-874-7800
  • Fax: 573-443-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberR7B63
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: