Individual
MRS. SUSAN DECOSTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
71958
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070016618
RAILROAD MEDICARE
—
05
—
3063534
—
MA
01
—
4292
HARVARD PILGRIM
—
01
—
724847
TUFTS
—
01
—
J09323
BC/BS
—
Enumeration date
12/06/2005
Last updated
06/19/2008
Update your record
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