Healthcare Provider Details

I. General information

NPI: 1649292764
Provider Name (Legal Business Name): DELINE M DA COSTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DELINE M MENEZES MD

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

3 SALJON CT
MAPLE GLEN PA
19002-3012
US

V. Phone/Fax

Practice location:
  • Phone: 908-847-6762
  • Fax:
Mailing address:
  • Phone: 908-847-6762
  • Fax: 215-728-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD428994
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MF00106500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: