Healthcare Provider Details

I. General information

NPI: 1790075737
Provider Name (Legal Business Name): CAITLYN MARGARET COSTANZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD STE 216
NEWARK DE
19713-2074
US

IV. Provider business mailing address

1100 WALNUT ST FL 5
PHILADELPHIA PA
19107-4944
US

V. Phone/Fax

Practice location:
  • Phone: 302-737-5444
  • Fax: 302-737-2697
Mailing address:
  • Phone: 215-955-8666
  • Fax: 215-955-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD449971
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC1-0026741
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: