Individual
DR. KATHLEEN A COSTANZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
311 W 24TH ST STE 305, ERIE, PA 16502-2666
(814) 454-4484
Mailing address
311 W 24TH ST STE 305, ERIE, PA 16502-2666
(814) 454-4484
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
OS014849
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102645606
—
PA
01
—
1602874
GATEWAY
PA
01
—
30106933
AMERIHEALTH MERCY - WMG
PA
01
—
417898
UPMC
PA
05
—
441180300
—
MD
Enumeration date
09/07/2011
Last updated
10/01/2020
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