Provider Demographics
NPI:1740217652
Name:COSTA, RALPH FLOYD (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:FLOYD
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 1:2301 E EVESHAM RD STE 407
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4505
Mailing Address - Country:US
Mailing Address - Phone:856-816-8317
Mailing Address - Fax:661-413-1142
Practice Address - Street 1:2301 E EVESHAM RD STE 407
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4505
Practice Address - Country:US
Practice Address - Phone:856-816-8317
Practice Address - Fax:661-413-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6359507Medicaid
NJ6359507Medicaid
NJ080058Medicare ID - Type Unspecified