MEDICARE: JOSE COSTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0101X	Anatomic Pathology Physician	032845	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083603617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE COSTA MD

Provider Business Mailing Address
First Line	:	PO BOX 9805
Second Line	:	300 GEORGE ST, 6TH FLOOR
City	:	NEW HAVEN
State	:	CT
Zip	:	06536-0805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 CEDAR ST
Second Line	:	LAUDER HALL ROOM 108
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-3218
Country	:	US
Telephone Number	:	203-785-2788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	06/26/2008

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