Provider Demographics
NPI:1255605697
Name:COSTA, MEGHAN RYAN (PA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:RYAN
Last Name:COSTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 IRVING AVE
Mailing Address - Street 2:SUITE 910 NEONATAL ASSOCIATES OF CENTRAL NEW YORK P.C.
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1690
Mailing Address - Country:US
Mailing Address - Phone:315-470-7379
Mailing Address - Fax:
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:SUITE 9100 NEONATAL ASSOCIATES OF CENTRAL NEW YORK P.C.
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-470-7379
Practice Address - Fax:315-470-2923
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015310-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015310-1OtherNEW YORK STATE LICENSE