Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 34009330 | OH |
NPI | 1033243175 |
---|---|
Provider Name | Dr. Andrea M Costanza |
First Address | Hilliard, OH 43026-2496 |
Second Address | Hilliard, OH 43026-2496 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 12/05/2011 |