Provider Demographics
NPI:1659394807
Name:COSTER, DANIEL L (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:COSTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2872 TURNPIKE STREET
Mailing Address - Street 2:
Mailing Address - City:SUSQUEHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18847-2771
Mailing Address - Country:US
Mailing Address - Phone:570-853-3135
Mailing Address - Fax:
Practice Address - Street 1:880 SR 6W
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657
Practice Address - Country:US
Practice Address - Phone:570-996-1221
Practice Address - Fax:570-836-0392
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004717L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012458590008Medicaid
PA411958OtherHIGHMARK BLUE SHIELD
PA826146OtherFIRST PRIORITY HEALTH
PA411958NUTMedicare PIN
PA826146OtherFIRST PRIORITY HEALTH