Individual
DR. THEODORE GERARD COSTICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
41 MAPLE RD, WILLIAMSVILLE, NY 14221-2918
(716) 631-1045
(716) 631-1365
Mailing address
41 MAPLE RD, WILLIAMSVILLE, NY 14221-2918
(716) 631-1045
(716) 631-1365
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
187420
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020006503
UNIVERA HEALTHCARE PROVID
NY
01
—
005250881
BC/BS OFWNY PROVIDER #
NY
05
—
01406720
—
NY
01
—
0709667
INDEPENDENT HEALTH PROVID
NY
01
—
10109001
FIDELIS PROVIDER #
NY
Enumeration date
09/26/2006
Last updated
09/04/2009
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