Provider Demographics
NPI:1649292764
Name:DA COSTA, DELINE M (MD)
Entity type:Individual
Prefix:
First Name:DELINE
Middle Name:M
Last Name:DA COSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DELINE
Other - Middle Name:M
Other - Last Name:MENEZES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3 SALJON CT
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3012
Mailing Address - Country:US
Mailing Address - Phone:908-847-6762
Mailing Address - Fax:215-728-2064
Practice Address - Street 1:185 ROSEBERRY ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1690
Practice Address - Country:US
Practice Address - Phone:908-847-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428994207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology