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:
Health care specialties
| Specialty | Code | License # | 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 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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