Provider Demographics
NPI:1417941451
Name:COSTANTINI, REGINA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:COSTANTINI
Suffix:
Gender:F
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:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0900
Mailing Address - Country:US
Mailing Address - Phone:410-876-3355
Mailing Address - Fax:410-848-3647
Practice Address - Street 1:193 STONER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5587
Practice Address - Country:US
Practice Address - Phone:410-876-3355
Practice Address - Fax:410-848-3647
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO42184207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD220701000Medicaid
MD220701000Medicaid
MD231777YBDBMedicare PIN