MEDICARE: DR. JOHN J. 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	207K00000X	Allergy & Immunology Physician	00000	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	J13636	OTHER		MEDICARE
7	056754	OTHER		TUFTS MEDICARE PREFERRED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0013922	OTHER	NHP
2	39485	OTHER	FALLON
3	056754	OTHER	TUFTS HEALTH CARE
4	1243	OTHER	HARVARD PILGRIM
6	J13636	OTHER	BCBSMA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	B20273502	OTHER	CIGNA

General Provider Information

NPI Number	:	1285633362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J. COSTA M.D.

Provider Business Mailing Address
First Line	:	33 COHASSET AVE
Second Line	:	UNIT #2
City	:	BUZZARDS BAY
State	:	MA
Zip	:	02532-3270
Country	:	US
Telephone Number	:	508-759-7555
Fax Number	:	508-759-7355

Provider Business Practice Location Address
First Line	:	33 COHASSET AVE
Second Line	:	UNIT #2
City	:	BUZZARDS BAY
State	:	MA
Zip	:	02532-3270
Country	:	US
Telephone Number	:	508-759-7555
Fax Number	:	508-759-7355

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	06/30/2015

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Directions to “ DR. JOHN J. COSTA M.D.” Practice Location

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