Provider Demographics
NPI:1740241546
Name:COSTA, SANDRA R (DO)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:R
Last Name:COSTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:RANIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3 WALNUT ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043
Mailing Address - Country:US
Mailing Address - Phone:717-909-0520
Mailing Address - Fax:717-909-4676
Practice Address - Street 1:3 WALNUT ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043
Practice Address - Country:US
Practice Address - Phone:717-909-0520
Practice Address - Fax:717-909-4676
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012622207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA168328OtherUNISON
PA1554362OtherGATEWAY
PA1013844070002Medicaid
PA50055274OtherCAPITAL BLUE CROSS
PA001761779OtherHIGHMARK BLUE CROSS
PA20046851OtherAMERIHEATLH
PA95094OtherGEISINGER
PA1013844070003Medicaid
PA001761779OtherHIGHMARK BLUE CROSS
I40601Medicare UPIN
PA1554362OtherGATEWAY
PA20046851OtherAMERIHEATLH