Basic Information
| Provider Information | |||||||||
| NPI: | 1770532228 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSTIC | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 MARKET ST | ||||||||
| Address2: | 24TH FLOOR-WEST TOWER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191022100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152553828 | ||||||||
| FaxNumber: | 2152553577 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 N BROAD ST | ||||||||
| Address2: | 744 NORTH TOWER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157627802 | ||||||||
| FaxNumber: | 2157621858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 04/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | OS010727L | PA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 0780001880 | 01 | RR MEDICARE | OTHER | 793392000 | 01 | NJ | AMERIHEALTH | OTHER | P390898 | 01 | NJ | OXFORD | OTHER | 793392000 | 01 | NJ | KEYSTONE HEALTHPLAN | OTHER | 939698 | 01 | NJ | INDEPENDENT BCBS | OTHER | 83491 | 01 | NJ | AMERIGROUP | OTHER | 102566398 | 05 | PA | MEDICAID | 1134236 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 6721303 | 05 | NJ | MEDICAID | 1000358600 | 01 | NJ | AMERICHOICE | OTHER | 1K6469 | 01 | NJ | HEALTHNET | OTHER | 2049399 | 01 | NJ | UNITED HEALTHCARE | OTHER | 2337132 | 01 | NJ | AETNA | OTHER | 29209 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER |