MEDICARE: MEGHAN COSTA MA

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1164256186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN COSTA MA

Provider Business Mailing Address
First Line	:	1521B POPLAR ST APT 1R
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1676
Country	:	US
Telephone Number	:	484-889-7661
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521B POPLAR ST APT 1R
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1676
Country	:	US
Telephone Number	:	484-889-7661
Fax Number	:

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

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	08/30/2024

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Directions to “ MEGHAN COSTA MA” Practice Location

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