Provider Demographics
NPI:1780144055
Name:COSTANZO, COREY JOAN (DO, MPH, MS)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:JOAN
Last Name:COSTANZO
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Gender:F
Credentials:DO, MPH, MS
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Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-8105
Practice Address - Street 1:151 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:MA
Practice Address - Zip Code:01005-9099
Practice Address - Country:US
Practice Address - Phone:978-355-6321
Practice Address - Fax:978-355-6549
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2022-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA291048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine