Healthcare Provider Details

I. General information

NPI: 1942326483
Provider Name (Legal Business Name): MEAGAN M COSTEDIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 RICHMOND RD
BEACHWOOD OH
44122-6046
US

IV. Provider business mailing address

14921 SHORE ACRES DR
CLEVELAND OH
44110-1238
US

V. Phone/Fax

Practice location:
  • Phone: 216-593-1315
  • Fax:
Mailing address:
  • Phone: 802-233-4189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35.095688
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: