Provider Demographics
NPI:1801024310
Name:COSTA, DENA GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:GRACE
Last Name:COSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENA
Other - Middle Name:GRACE
Other - Last Name:CARALIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6939 COX RD STE 350
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7595
Mailing Address - Country:US
Mailing Address - Phone:513-564-1600
Mailing Address - Fax:513-564-1624
Practice Address - Street 1:6939 COX RD STE 350
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-564-1600
Practice Address - Fax:513-564-1624
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35121483207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086859Medicaid
OHH220550Medicare PIN