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General NPI Number Information
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NPI Number | 1316914047
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Entity Type | Individual
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Provider Name | MARCO A COSTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 3605 WARRENSVILLE CENTER RD 1ST FLOOR
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-5203
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Country | US
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Telephone | 216-286-6295
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Fax | 216-286-6341
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MFC1413
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 81-000076
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 81-000083
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License Number State | OH
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