Provider Demographics
NPI:1689906737
Name:COSTIC, DONALD JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOSEPH
Last Name:COSTIC
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 601076
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1076
Mailing Address - Country:US
Mailing Address - Phone:828-580-6752
Mailing Address - Fax:828-580-6754
Practice Address - Street 1:350 E PARKER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5155
Practice Address - Country:US
Practice Address - Phone:828-580-2700
Practice Address - Fax:828-432-9833
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-30
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.095554208M00000X
OH35-095554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3077147Medicaid
OH4295951Medicare PIN