Individual
DR. MARK EDWARD COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
361 WOODWARD ST, WABAN, MA 02468-2027
(617) 777-4080
(617) 224-4306
Mailing address
361 WOODWARD ST, WABAN, MA 02468-2027
(617) 777-4080
(617) 224-4306
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
54772
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054772
TUFTS HEALTH PLAN
MA
05
—
3131874
—
MA
01
—
J10005
BCBS MA
MA
Enumeration date
10/26/2005
Last updated
08/27/2009
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