Individual
STEPHANIE COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1315 W LANE AVE, SUITE D, COLUMBUS, OH 43221-3538
(614) 457-4827
(614) 457-4832
Mailing address
1315 W LANE AVE, SUITE D, COLUMBUS, OH 43221-3538
(614) 457-4827
(614) 457-4832
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
35069599
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201308320030
CARESOURCE
OH
05
—
2053530
—
OH
01
—
2586296
GROUP MEDICAID
OH
01
—
4125142
MEDICARE PTAN
OH
Enumeration date
10/11/2006
Last updated
10/25/2011
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