Individual
MARTHA J MASCIOPINTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10010 KIMBRO AVE S, COTTAGE GROVE, MN 55016-4151
(651) 769-0407
(651) 769-0407
Mailing address
10010 KIMBRO AVE S, COTTAGE GROVE, MN 55016-4151
(651) 769-0407
(651) 769-0407
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37447
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064727600
—
MN
Enumeration date
05/18/2006
Last updated
03/04/2010
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