Provider Demographics
NPI:1073549093
Name:COSTANZO, RALPH M (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:M
Last Name:COSTANZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N STE 100E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7504
Mailing Address - Country:US
Mailing Address - Phone:406-652-5261
Mailing Address - Fax:406-238-6734
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:#100E
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6700
Practice Address - Fax:406-238-6734
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10383207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0065559Medicaid
WYW21089Medicare PIN
WY21089Medicare PIN
MT0065559Medicaid