Provider Demographics
NPI:1942464649
Name:COSTA, MATTHEW J (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:COSTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:
Practice Address - Street 1:100 ROSEBROOK WAY
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1138
Practice Address - Country:US
Practice Address - Phone:508-273-4950
Practice Address - Fax:508-273-1890
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA242385207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease