Provider Demographics
NPI:1104840586
Name:KOSTICK, BARBARA HUGHES (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:HUGHES
Last Name:KOSTICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38069 MARTHA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3811
Mailing Address - Country:US
Mailing Address - Phone:510-608-4800
Mailing Address - Fax:
Practice Address - Street 1:38069 MARTHA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3811
Practice Address - Country:US
Practice Address - Phone:510-608-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA943300810OtherTAX ID
CAZZZ21188ZMedicaid
CAA42292Medicare UPIN