Provider Demographics
NPI:1235123530
Name:KOSTINER, GEOFFREY B (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:B
Last Name:KOSTINER
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 1:860 OMNI BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:SUITE # 205
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4237
Practice Address - Country:US
Practice Address - Phone:757-873-2562
Practice Address - Fax:757-873-2570
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056471208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
340014547OtherRR/MEDICARE
VA174990OtherANTHEM
VA010131561Medicaid
VA174990OtherANTHEM
VA006792T25Medicare ID - Type Unspecified