Healthcare Provider Details

I. General information

NPI: 1093899254
Provider Name (Legal Business Name): ANTHONY JOSEPH COSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 STATE ROUTE 44 NEOUCOM
ROOTSTOWN OH
44272
US

IV. Provider business mailing address

3193 PIMLICO BLVD
STOW OH
44224
US

V. Phone/Fax

Practice location:
  • Phone: 330-325-6767
  • Fax: 330-325-5903
Mailing address:
  • Phone: 330-686-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35039375
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number1561808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: