Basic Information
| Provider Information | |||||||||
| NPI: | 1740241546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RANIERI | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3 WALNUT ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179090520 | ||||||||
| FaxNumber: | 7179094676 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 WALNUT ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179090520 | ||||||||
| FaxNumber: | 7179094676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 05/08/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS012622 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | OS012622 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 168328 | 01 | PA | UNISON | OTHER | 1554362 | 01 | PA | GATEWAY | OTHER | 1013844070002 | 05 | PA | MEDICAID | 50055274 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 001761779 | 01 | PA | HIGHMARK BLUE CROSS | OTHER | 20046851 | 01 | PA | AMERIHEATLH | OTHER | 95094 | 01 | PA | GEISINGER | OTHER | 1013844070003 | 05 | PA | MEDICAID |