Provider Demographics
NPI:1295872976
Name:COSTEA MISTHOS, MARIA (MD)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:COSTEA MISTHOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N FINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920
Mailing Address - Country:US
Mailing Address - Phone:908-696-1400
Mailing Address - Fax:908-696-9900
Practice Address - Street 1:1 ANDERSON HILL RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2350
Practice Address - Country:US
Practice Address - Phone:908-696-0808
Practice Address - Fax:908-696-9943
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E22102Medicare UPIN
560934Medicare ID - Type Unspecified