Healthcare Provider Details

I. General information

NPI: 1750919940
Provider Name (Legal Business Name): CATHERINE COSTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 VOLVO PKWY
CHESAPEAKE VA
23320-2855
US

IV. Provider business mailing address

817 VOLVO PKWY
CHESAPEAKE VA
23320-2855
US

V. Phone/Fax

Practice location:
  • Phone: 757-932-3525
  • Fax:
Mailing address:
  • Phone: 757-932-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116033855
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: