Provider Demographics
NPI:1467625228
Name:COSTA, GERALD P (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:P
Last Name:COSTA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BARNARD RD
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:MA
Mailing Address - Zip Code:01256-9245
Mailing Address - Country:US
Mailing Address - Phone:413-743-8006
Mailing Address - Fax:
Practice Address - Street 1:1 BERKSHIRE SQ
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1300
Practice Address - Country:US
Practice Address - Phone:413-743-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108219367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0565Medicare PIN