Provider Demographics
NPI:1982269882
Name:COSTON, DELVIN (MD)
Entity Type:Individual
Prefix:MR
First Name:DELVIN
Middle Name:
Last Name:COSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:DELVIN
Other - Middle Name:
Other - Last Name:COSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4445 NOBLE CANE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-8042
Mailing Address - Country:US
Mailing Address - Phone:225-369-9448
Mailing Address - Fax:
Practice Address - Street 1:4445 NOBLE CANE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-8042
Practice Address - Country:US
Practice Address - Phone:225-369-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9076107172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver