Provider Demographics
NPI:1679575856
Name:COSTACURTA, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:COSTACURTA
Suffix:
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:848-844-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:2001 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3915
Practice Address - Country:US
Practice Address - Phone:610-442-2082
Practice Address - Fax:610-438-2419
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA054780207RC0000X, 207RI0011X
PAMD034283-E207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5089603Medicaid
PA597435OtherKEYSTONE CAPITAL
PA1198810Medicaid
NJ1387642OtherHIGHMARK NJ
PAP713649OtherOXFORD
PA485897OtherAETNA US HEALTHCARE
PA20008705OtherAMERIHEALTH MERCY MA
PA4005656OtherCIGNA PA
PA1951701OtherCAPITAL BLUE CROSS
PA597435OtherHIGHMARK BLUE SHIELD PA
NJ1387642OtherHIGHMARK NJ
PA1198810Medicaid
NJ026850M9RMedicare PIN