Individual
GILLIAN COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
CAG 1, 1640 TOMCAT BLVD STE 100, VIRGINIA BEACH, VA 23460-2227
(757) 953-3933
Mailing address
1640 TOMCAT BLVD STE 100, VIRGINIA BEACH, VA 23460-2227
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
0101276109
VA
171000000X
Military Health Care Provider
—
—
Other
Enumeration date
03/10/2021
Last updated
12/26/2024
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