Provider Demographics
NPI:1598856858
Name:COSTARINO, ANDREW T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:T
Last Name:COSTARINO
Suffix:JR
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 1:100 E PENN SQUARE
Mailing Address - Street 2:WANAMAKER BLDG., 9TH FL, N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-0001
Mailing Address - Country:US
Mailing Address - Phone:267-425-9320
Mailing Address - Fax:267-425-9331
Practice Address - Street 1:3401 CIVIC CENTER BLVD STE 9329
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1858
Practice Address - Fax:267-425-9331
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006289207L00000X, 207LP3000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ496804Medicaid
MD2835100Medicaid
VA6736441Medicaid
NY1642039Medicaid
NC7611115Medicaid
PA963171Medicaid
SCQ4937EMedicaid
DC410070Medicaid
NJ496804Medicaid
VA6736441Medicaid