Costa, Marc Lance

Costa, Marc Lance is an individual health care provider with primary practice located at 527 Medical Park Dr Suite 202, Bridgeport WV 26330-9008. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Costa, Marc Lance can be contacted via phone (304) 933-3850.

Contact Information

Primary practice address
527 Medical Park Dr Suite 202 Bridgeport WV 26330-9008
Phone: (304) 933-3850
Fax: (304) 933-3859
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X MD060675L Pennsylvania
Allopathic & Osteopathic Physicians / Surgery 208600000X 19442 West Virginia

Profile Details

NPI number 1184655482
LBN Legal business name Costa, Marc Lance
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2006
Last updated Apr 5th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184655482 NPPES
Pennsylvania Other 000000140320 UNISON THREE RIVERS
Pennsylvania Other 048032003 UNISON THREE RIVERS
Pennsylvania Other G78377 UNISON THREE RIVERS
Pennsylvania Other G78377 UNISON THREE RIVERS
Pennsylvania Other 1461312 UNISON THREE RIVERS
Pennsylvania Other 1531290 UNISON THREE RIVERS
Pennsylvania MEDICAID 0019436000001 UNISON THREE RIVERS
Pennsylvania Other 3133024 UNISON THREE RIVERS
Pennsylvania Other G78377 UNISON THREE RIVERS
Pennsylvania Other 319922 UNISON THREE RIVERS

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