Individual
RICHARD C COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
339 N ROUTE 73, SUITE 1, BERLIN, NJ 08009-9707
(856) 767-8228
(856) 753-7836
Mailing address
40 LAKE CTR, 401 ROUTE 73 NORTH SUITE 201A, MARLTON, NJ 08053-3425
(856) 355-0340
(856) 355-0346
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MB48420
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2098601
—
NJ
Enumeration date
10/17/2005
Last updated
12/19/2013
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