Individual
GREGORY COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
620 HALTON RD APT 7101, GREENVILLE, SC 29607-3486
(323) 401-5141
Mailing address
620 HALTON RD APT 7101, GREENVILLE, SC 29607-3486
(323) 401-5141
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
016288
NY
363A00000X
Physician Assistant
PAL2348
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25621530
—
CO
Enumeration date
01/19/2007
Last updated
06/26/2019
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