MEDICARE: JOSEPH COSTAGLIOLA 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	207R00000X	Internal Medicine Physician	59942	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	:	1972507242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH COSTAGLIOLA M.D.

Provider Business Mailing Address
First Line	:	66 CONCORD STREET
Second Line	:	LAHEY WILMINGTON
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2127
Country	:	US
Telephone Number	:	978-694-9610
Fax Number	:	978-694-9533

Provider Business Practice Location Address
First Line	:	66 CONCORD STREET
Second Line	:	LAHEY WILMINGTON
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2127
Country	:	US
Telephone Number	:	978-694-9610
Fax Number	:	978-694-9533

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	01/22/2016

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