Individual
DR. CASEY GRANT COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1213 E CLAY ST, RICHMOND, VA 23298-5071
(804) 828-0996
(804) 828-0996
Mailing address
PO BOX 980257, RICHMOND, VA 23298-0257
(804) 828-9783
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0116037906
VA
Other
Enumeration date
04/06/2023
Last updated
06/26/2024
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