Provider Demographics
NPI:1770532228
Name:COSTIC, JOSEPH THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:COSTIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 MARKET ST
Mailing Address - Street 2:24TH FLOOR-WEST TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2100
Mailing Address - Country:US
Mailing Address - Phone:215-255-3828
Mailing Address - Fax:215-255-3577
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 1E50
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-1121
Practice Address - Country:US
Practice Address - Phone:302-733-1980
Practice Address - Fax:302-733-1985
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010727L208G00000X
DEC2-0024404208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0780001880OtherRR MEDICARE
NJ2337132OtherAETNA
NJ29209OtherUNIVERSITY HEALTH PLAN
NJ793392000OtherAMERIHEALTH
NJ1134236OtherHORIZON NJ HEALTH
NJ939698OtherINDEPENDENT BCBS
NJ83491OtherAMERIGROUP
NJ1000358600OtherAMERICHOICE
NJ793392000OtherKEYSTONE HEALTHPLAN
NJP390898OtherOXFORD
NJ2049399OtherUNITED HEALTHCARE
NJ6721303Medicaid
PA102566398Medicaid
NJ1K6469OtherHEALTHNET
0780001880OtherRR MEDICARE
NJ793392000OtherKEYSTONE HEALTHPLAN
PA102566398Medicaid