Provider Demographics
NPI:1417103128
Name:COSTANZO, GARY (PA)
Entity Type:Individual
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First Name:GARY
Middle Name:
Last Name:COSTANZO
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Gender:M
Credentials:PA
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Mailing Address - Street 1:250 PLEASANT STREET
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2598
Mailing Address - Country:US
Mailing Address - Phone:603-227-7000
Mailing Address - Fax:603-230-7218
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2830
Practice Address - Fax:603-663-1849
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2015-10-14
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Provider Licenses
StateLicense IDTaxonomies
NH0686363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical