MEDICARE: JONATHAN COSTA DO

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	208M00000X	Hospitalist Physician	223964	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA37712	OTHER	MA	HPHC
2	J28869	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1821065244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN COSTA DO

Provider Business Mailing Address
First Line	:	100 TER HEUN DR
Second Line	:	FALMOUTH HOSPITAL
City	:	FALMOUTH
State	:	MA
Zip	:	02540-2503
Country	:	US
Telephone Number	:	508-457-3748
Fax Number	:	508-457-3749

Provider Business Practice Location Address
First Line	:	100 TER HEUN DR
Second Line	:	FALMOUTH HOSPITAL HOSPITALIST DEPARTMENT
City	:	FALMOUTH
State	:	MA
Zip	:	02540-2503
Country	:	US
Telephone Number	:	508-457-3748
Fax Number	:	508-457-3749

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/08/2007

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Directions to “ JONATHAN COSTA DO” Practice Location

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