Provider Demographics
NPI:1801856851
Name:COSTAS, PAUL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:COSTAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 ORNAC
Mailing Address - Street 2:JOHN CUMING BLDG STE 850
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4177
Mailing Address - Country:US
Mailing Address - Phone:978-369-1579
Mailing Address - Fax:978-369-0304
Practice Address - Street 1:131 ORNAC
Practice Address - Street 2:JOHN CUMING BLDG STE 850
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4177
Practice Address - Country:US
Practice Address - Phone:978-369-1579
Practice Address - Fax:978-369-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA706652086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA21600OtherHARVARD PILGRIM HEALTH PL
MA719949OtherTUFTS HEALTH PLAN
MAJ11048OtherBLUE CROSS BLUE SHIELD
MA21600OtherHARVARD PILGRIM HEALTH PL
MAJ11048OtherBLUE CROSS BLUE SHIELD