Provider Demographics
NPI:1033243175
Name:COSTANZA, ANDREA M (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:COSTANZA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3853 TRUEMAN CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-2496
Mailing Address - Country:US
Mailing Address - Phone:614-777-1200
Mailing Address - Fax:614-777-1294
Practice Address - Street 1:3853 TRUEMAN CT
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2496
Practice Address - Country:US
Practice Address - Phone:614-777-1200
Practice Address - Fax:614-777-1294
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009330207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4261271Medicare PIN