Healthcare Provider Details

I. General information

NPI: 1740270941
Provider Name (Legal Business Name): TAMMY RENEE MASCHINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N KELLY AVE, STE 200
EDMOND OK
73003-3008
US

IV. Provider business mailing address

2800 N KELLY AVE, STE 200
EDMOND OK
73003-3008
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-8000
  • Fax: 405-726-8101
Mailing address:
  • Phone: 405-726-8000
  • Fax: 405-726-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21370
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: