Costa, Mark Edward

Costa, Mark Edward is an sole proprietor health care provider with primary practice located at 361 Woodward St , Waban MA 02468-2027. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Costa, Mark Edward can be contacted via phone (617) 777-4080.

Contact Information

Primary practice address
361 Woodward St Waban MA 02468-2027
Phone: (617) 777-4080
Fax: (617) 224-4306
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 54772 Massachusetts

Profile Details

NPI number 1912997420
LBN Legal business name Costa, Mark Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 26th, 2005
Last updated Aug 27th, 2009 - about 15 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 1912997420 NPPES
Massachusetts Other 054772 TUFTS HEALTH PLAN
Massachusetts Other J10005 TUFTS HEALTH PLAN
Massachusetts MEDICAID 3131874 TUFTS HEALTH PLAN

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