Healthcare Provider Details

I. General information

NPI: 1760438568
Provider Name (Legal Business Name): AMY A COSTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDWAY RD STE 204
MILFORD MA
01757-2923
US

IV. Provider business mailing address

9 INDUSTRIAL RD STE 5
MILFORD MA
01757-3736
US

V. Phone/Fax

Practice location:
  • Phone: 508-482-5444
  • Fax: 508-482-5408
Mailing address:
  • Phone: 508-473-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number226744
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number226744
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: