1659394807 NPI number — DANIEL L COSTER D.O.

Table of content: DANIEL L COSTER D.O. (NPI 1659394807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659394807 NPI number — DANIEL L COSTER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTER
Provider First Name:
DANIEL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659394807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2872 TURNPIKE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUSQUEHANNA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18847-2771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-853-3135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 SR 6W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-996-1221
Provider Business Practice Location Address Fax Number:
570-836-0392
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  OS004717L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0012458590008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411958 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 826146 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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