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General NPI Number Information
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NPI Number | 1073790572
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Entity Type | Individual
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Provider Name | PAUL T COSTA JR. PHD
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Gender | Male
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 250 BAYVIEW BLVD
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City | BALTIMORE
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State | MD
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Zip | 21224
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Country | US
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Telephone | 410-558-8220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 728
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City | OWINGS MILLS
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State | MD
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Zip | 21117-0728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 451
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License Number State | MA
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