Healthcare Provider Details

I. General information

NPI: 1740217652
Provider Name (Legal Business Name): RALPH F. COSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S WHITE HORSE PIKE FRNT
HAMMONTON NJ
08037-1872
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-561-0128
  • Fax: 609-461-4468
Mailing address:
  • Phone: 609-561-0128
  • Fax: 609-561-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05022600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: