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General NPI Number Information
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NPI Number | 1902011158
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Entity Type | Individual
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Provider Name | GASTON DA COSTA MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 740 S LIMESTONE STE B101
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City | LEXINGTON
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State | KY
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Zip | 40536-8947
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Country | US
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Telephone | 859-323-5661
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Fax | 859-323-6411
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE STE 130
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01063806A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036146545
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD463417
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 11010836A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 59121
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License Number State | KY
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