Provider Demographics
NPI:1689691768
Name:COSTIN, MIHAELA (MD)
Entity Type:Individual
Prefix:
First Name:MIHAELA
Middle Name:
Last Name:COSTIN
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 1:7365 MAIN ST
Mailing Address - Street 2:BRIDGEPORT ANESTHESIA ASSOCIATES, P.C.
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1300
Mailing Address - Country:US
Mailing Address - Phone:203-384-3174
Mailing Address - Fax:
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:BRIDGEPORT ANESTHESIA ASSOCIATES, P.C.
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-384-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1411214207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001411214P1OtherBLUE CARE FAMILY PLAN
CT050001413OtherMEDICARE PTAN
CT060855634OtherCOMMUNITY HEALTH NETWORK
CT1411214Medicaid
CT3666614OtherCIGNA CT
CT755634OtherCONNECTICARE
CT500HBA011CT01OtherBCBS CT
CTP00134657OtherRAILROAD MEDICARE
CT1411214Medicaid