1740241546 NPI number — DR. SANDRA R COSTA DO

Table of content: DR. SANDRA R COSTA DO (NPI 1740241546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740241546 NPI number — DR. SANDRA R COSTA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTA
Provider First Name:
SANDRA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RANIERI
Provider Other First Name:
SANDRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740241546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
LEMOYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-909-0520
Provider Business Mailing Address Fax Number:
717-909-4676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-909-0520
Provider Business Practice Location Address Fax Number:
717-909-4676
Provider Enumeration Date:
03/31/2006

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: 207Q00000X , with the licence number:  OS012622 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: OS012622 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 168328 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1554362 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1013844070002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50055274 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001761779 . This is a "HIGHMARK BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20046851 . This is a "AMERIHEATLH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 95094 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1013844070003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com