Provider Demographics
NPI:1942374079
Name:COSTA, LEON N (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:N
Last Name:COSTA
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 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-510-6200
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-510-6200
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260585207X00000X
NJ25MAO4609200207X00000X
VA0101-260585207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942374079Medicaid
VA1942374079OtherUNITED HEALTHCARE
VA1942374079OtherOPTIMA HEALTH PLAN
VA1942374079OtherHEALTHKEEPERS PLUS
VA1942374079OtherTRICARE
VA1942374079OtherAETNA
VA1942374079OtherHEALTHKEEPERS
VA1942374079OtherCIGNA
VA1942374079OtherVIRGINIA PREMIER
VA1942374079OtherGATEWAY
VA1942374079OtherVIRGINIA HEALTH NETWORK
VA1942374079OtherINTOTAL
VA1942374079OtherWEST VIRGINIA MEDICAID
VA1942374079OtherHUMANA MEDICARE
VA1942374079OtherCOVENTRY/AETNA BETTER HEALTH
VA1942374079OtherANTHEM BLUECROSS BLUESHIELD
VA1942374079OtherUNITED MINE WORKERS ASSOCIATION