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NPI Code Detail

MEDICARE: MRS. NANCY ELIZABETH COSTA D.O.

MEDICARE: MRS. NANCY ELIZABETH COSTA D.O.
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
1390200000XStudent in an Organized Health Care Education/Training ProgramOH
2207Q00000XFamily Medicine Physician34.011541OH

General Provider Information

NPI Number : 1215374038
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NANCY ELIZABETH COSTA D.O.
Provider Business Mailing Address
First Line : 68 DARST RD
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45440-3442
Country : US
Telephone Number : 937-531-0132
Fax Number : 937-531-0134
Provider Business Practice Location Address
First Line : 68 DARST RD
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45440-3442
Country : US
Telephone Number : 937-531-0132
Fax Number : 937-531-0134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2013
Last Update Date : 01/28/2021

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