Provider Demographics
NPI:1689672438
Name:COSTANZO, PATRICIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:COSTANZO
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 1:4 SEA OATS LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-3102
Mailing Address - Country:US
Mailing Address - Phone:912-598-3960
Mailing Address - Fax:912-598-3961
Practice Address - Street 1:4 SEA OATS LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-3102
Practice Address - Country:US
Practice Address - Phone:912-598-3960
Practice Address - Fax:912-598-3961
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036709207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000835986CMedicaid
GA768294OtherBLUECROSS BLUESHIELD
SCG36709Medicaid
C53251Medicare UPIN
511I290005Medicare PIN