Provider Demographics
NPI:1184826273
Name:COSTA, DARY JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DARY
Middle Name:JONATHAN
Last Name:COSTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:411 E CHESTNUT ST # LEVEL6
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1713
Practice Address - Country:US
Practice Address - Phone:502-588-9587
Practice Address - Fax:502-588-9580
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-11-29
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Provider Licenses
StateLicense IDTaxonomies
KYTP891207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology