Healthcare Provider Details

I. General information

NPI: 1013541945
Provider Name (Legal Business Name): MR. JOSHUA COSTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 FAUNCE CORNER RD
NORTH DARTMOUTH MA
02747-6244
US

IV. Provider business mailing address

200 MILL RD
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-995-0700
  • Fax: 508-973-1355
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2302449
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: