Basic Information
| Provider Information | |||||||||
| NPI: | 1821065244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 TER HEUN DR | ||||||||
| Address2: | FALMOUTH HOSPITAL | ||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025402503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084573748 | ||||||||
| FaxNumber: | 5084573749 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 TER HEUN DR | ||||||||
| Address2: | FALMOUTH HOSPITAL HOSPITALIST DEPARTMENT | ||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025402503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084573748 | ||||||||
| FaxNumber: | 5084573749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 223964 | MA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | AA37712 | 01 | MA | HPHC | OTHER | J28869 | 01 | MA | BCBS | OTHER |