Provider Demographics
NPI:1972507242
Name:COSTAGLIOLA, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:COSTAGLIOLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:66 CONCORD STREET
Mailing Address - Street 2:LAHEY WILMINGTON
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2127
Mailing Address - Country:US
Mailing Address - Phone:978-694-9610
Mailing Address - Fax:978-694-9533
Practice Address - Street 1:66 CONCORD STREET
Practice Address - Street 2:LAHEY WILMINGTON
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2127
Practice Address - Country:US
Practice Address - Phone:978-694-9610
Practice Address - Fax:978-694-9533
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2016-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA59942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110045692AMedicaid
MAJ0729301Medicare PIN
MA1972507242OtherAETNA HMO
4959664OtherCIGNA
MAJ07293OtherHARVARD PILGRIM HEALTHCAR
MA110045692AMedicaid
04-08179OtherEVERCARE
110214715OtherRAILROAD MEDICARE
MA5947482OtherAETNA NON HMO
MA1972507242OtherFALLON COMMUNITY HEALTH PLAN
MAJ0729301Medicare PIN
NH30004150OtherNEW HAMPSHIRE MEDICAID
NHB74977OtherANTHEM BLUE CROSS
0016276OtherNEIGHBORHOOD HEALTH PLAN
974556OtherNETWORK HEALTH
MAJ07293OtherBLUE CROSS BLUE SHIELD
MAB74977Medicare UPIN