Individual
MARC LANCE COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
527 MEDICAL PARK DR, SUITE 202, BRIDGEPORT, WV 26330-9008
(304) 933-3850
(304) 933-3859
Mailing address
527 MEDICAL PARK DR, SUITE 202, BRIDGEPORT, WV 26330-9008
(304) 933-3850
(304) 933-3859
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD060675L
PA
208600000X
Surgery Physician
Primary
19442
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000140320
UNISON THREE RIVERS
PA
05
—
0019436000001
—
PA
01
—
048032003
CIGNA
PA
01
—
1461312
BLUE CROSS BLUE SHIELD
PA
01
—
1531290
GATEWAY
PA
01
—
3133024
AETNA
PA
01
—
319922
UPMC MEDICARE
PA
01
—
G78377
HEALTH AMERICA
PA
Enumeration date
07/05/2006
Last updated
04/05/2022
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