1679694723 NPI number — LOUIS E COSTA DO

Table of content: LOUIS E COSTA DO (NPI 1679694723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679694723 NPI number — LOUIS E COSTA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTA
Provider First Name:
LOUIS
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1679694723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 GLENDA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19901-4922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-505-0045
Provider Business Mailing Address Fax Number:
888-873-9653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 BEISER BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904-7792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-505-0045
Provider Business Practice Location Address Fax Number:
888-873-9653
Provider Enumeration Date:
04/03/2007

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: 208600000X , with the licence number:  C20010788 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C2-0010788 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 102197454 0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: OS012657 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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