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General NPI Number Information
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NPI Number | 1790075737
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Entity Type | Individual
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Provider Name | CAITLYN MARGARET COSTANZO M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 4745 OGLETOWN STANTON RD STE 216
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City | NEWARK
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State | DE
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Zip | 19713-2074
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Country | US
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Telephone | 302-737-5444
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Fax | 302-737-2697
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Provider Business Mailing Address
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Address Line | 1100 WALNUT ST FL 5
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4944
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Country | US
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Telephone | 215-955-8666
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Fax | 215-955-2878
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD449971
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C1-0026741
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License Number State | DE
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