Provider Demographics
NPI:1285633362
Name:COSTA, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:COSTA
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 1:33 COHASSET AVE
Mailing Address - Street 2:UNIT #2
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3270
Mailing Address - Country:US
Mailing Address - Phone:508-759-7555
Mailing Address - Fax:508-759-7355
Practice Address - Street 1:33 COHASSET AVE
Practice Address - Street 2:UNIT #2
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02532-3270
Practice Address - Country:US
Practice Address - Phone:508-759-7555
Practice Address - Fax:508-759-7355
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00000207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0013922OtherNHP
39485OtherFALLON
056754OtherTUFTS HEALTH CARE
1243OtherHARVARD PILGRIM
J13636OtherMEDICARE
J13636OtherBCBSMA
056754OtherTUFTS MEDICARE PREFERRED
MA3118258Medicaid
B20273502OtherCIGNA
056754OtherTUFTS HEALTH CARE
042297845OtherHCVM/FIRST HEALTH/COVENTY
042297845OtherGREAT WEST HEALTH CARE
042297845OtherTRICARE
MA3118258Medicaid
1243OtherHARVARD PILGRIM
B20273502OtherCIGNA
J13636OtherMEDICARE