Provider Demographics
NPI:1811976632
Name:COSCIA, DIANNE E (MD)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:E
Last Name:COSCIA
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 1:10 GOVE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1920
Mailing Address - Country:US
Mailing Address - Phone:617-569-5800
Mailing Address - Fax:617-568-4780
Practice Address - Street 1:1 POCHICK STREET
Practice Address - Street 2:
Practice Address - City:SIASCONSET
Practice Address - State:MA
Practice Address - Zip Code:02564
Practice Address - Country:US
Practice Address - Phone:646-284-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223858208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2104415Medicaid
MAI30724Medicare UPIN
MAA38429Medicare ID - Type Unspecified