Provider Demographics
NPI:1184653842
Name:D'COSTA, GINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:D'COSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:793 EASTERN BYP
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2422
Mailing Address - Country:US
Mailing Address - Phone:859-624-6560
Mailing Address - Fax:859-624-6560
Practice Address - Street 1:793 EASTERN BYPASS
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2440
Practice Address - Country:US
Practice Address - Phone:859-624-6560
Practice Address - Fax:859-624-6569
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY39044207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64094576Medicaid
KYI25566Medicare UPIN
KY01092002Medicare PIN