MEDICARE: MRS. NELI COSTA R.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
1	156FX1800X	Optician	5945	MA

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	:	1811017221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NELI COSTA R.D.O

Provider Business Mailing Address
First Line	:	846 ASHLEY BLVD
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02745-2403
Country	:	US
Telephone Number	:	508-995-6000
Fax Number	:	508-995-7067

Provider Business Practice Location Address
First Line	:	846 ASHLEY BLVD
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02745-2403
Country	:	US
Telephone Number	:	508-995-6000
Fax Number	:	508-995-7067

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	05/26/2016

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