MEDICARE: DR. HENRY COSTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	K0009	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00W602	OTHER		MEDICARE PROVIDER GROUP
3	DF4091	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134125651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY COSTA M.D.

Provider Business Mailing Address
First Line	:	7812 GATEWAY BLVD E
Second Line	:	SUITE 200
City	:	EL PASO
State	:	TX
Zip	:	79915-1803
Country	:	US
Telephone Number	:	915-592-6868
Fax Number	:	915-592-6889

Provider Business Practice Location Address
First Line	:	10555 VISTA DEL SOL DR
Second Line	:	STE 120
City	:	EL PASO
State	:	TX
Zip	:	79925-7942
Country	:	US
Telephone Number	:	915-592-6868
Fax Number	:	915-592-6889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	09/03/2010

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Directions to “ DR. HENRY COSTA M.D.” Practice Location

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