MEDICARE: ALLERGY AND ASTHMA ASSOCIATES - SOUTH, P.C.

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

General Provider Information

NPI Number	:	1447259536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY AND ASTHMA ASSOCIATES - SOUTH, P.C.

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	:	PRESIDENT
Name	:	DR. JOHN J. COSTA
Credential	:	M.D.
Telephone Number	:	508-759-7555

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/18/2013

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