Individual
MARK A COSTANZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2018027810
MO
363LP0200X
Pediatric Nurse Practitioner
78321
KS
363LP0200X
Pediatric Nurse Practitioner
RN2368659
MA
Other
Enumeration date
08/13/2018
Last updated
04/29/2026
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