Individual
DR. EFREN COSTIBOLO GO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1720 S BROAD ST, HEALTH CARE CENTER #2, PHILADELPHIA, PA 19145-2315
(215) 685-1803
(215) 683-1815
Mailing address
500 S BROAD ST, SUITE 360, PHILADELPHIA, PA 19146-1613
(215) 685-6769
(215) 685-6732
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD046838L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014257120001
—
PA
Enumeration date
08/13/2006
Last updated
07/08/2007
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