Individual
JOSE COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 CEDAR ST, LAUDER HALL ROOM 108, NEW HAVEN, CT 06510-3218
(203) 785-2788
Mailing address
PO BOX 9805, 300 GEORGE ST, 6TH FLOOR, NEW HAVEN, CT 06536-0805
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
032845
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001328451
—
CT
Enumeration date
10/17/2005
Last updated
06/26/2008
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