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General NPI Number Information
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NPI Number | 1770532228
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Entity Type | Individual
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Provider Name | JOSEPH THOMAS COSTIC DO
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 4755 OGLETOWN STANTON RD STE 1E50
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City | NEWARK
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State | DE
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Zip | 19718-1121
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Country | US
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Telephone | 302-733-1980
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Fax | 302-733-1985
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Provider Business Mailing Address
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Address Line | 1500 MARKET ST 24TH FLOOR-WEST TOWER
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2100
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Country | US
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Telephone | 215-255-3828
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Fax | 215-255-3577
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | OS010727L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | C2-0024404
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License Number State | DE
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