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General NPI Number Information
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NPI Number | 1154300739
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Entity Type | Individual
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Provider Name | DAMIAN P DICOSTANZO MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 100 MIDLAND AVE
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City | PORT CHESTER
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State | NY
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Zip | 10573-4943
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Country | US
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Telephone | 800-942-3376
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Fax | 914-934-9819
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Provider Business Mailing Address
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Address Line | 14275 MIDWAY RD SUITE 400
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City | ADDISON
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State | TX
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Zip | 75001-3614
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Country | US
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Telephone | 214-932-8029
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Fax | 610-271-4245
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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 | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 168313
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 168313
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License Number State | NY
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