Healthcare Provider Details

I. General information

NPI: 1275063562
Provider Name (Legal Business Name): MATTHEW ABRANTES COSTA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 BALTIMORE PIKE STE 100
CHADDS FORD PA
19317-7373
US

IV. Provider business mailing address

PO BOX 5228
WEST CHESTER PA
19380-0405
US

V. Phone/Fax

Practice location:
  • Phone: 610-789-7767
  • Fax:
Mailing address:
  • Phone: 610-359-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS020401
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT018108
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: