Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 35165 | MA |
NPI | 1063585370 |
---|---|
Provider Name | John M F Costa |
First Address | Swansea, MA 02777-2910 |
Second Address | Swansea, MA 02777-2910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |