Basic Information
| Provider Information | |||||||||
| NPI: | 1679575856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSTACURTA | ||||||||
| FirstName: | GARY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8488444500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 FAIRVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180423915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104422082 | ||||||||
| FaxNumber: | 6104382419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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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 | 207RC0000X | MA054780 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | MD034283-E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | MA054780 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | MD034283-E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 5089603 | 05 | NJ | MEDICAID | 597435 | 01 | PA | KEYSTONE CAPITAL | OTHER | 1198810 | 05 | PA | MEDICAID | 1387642 | 01 | NJ | HIGHMARK NJ | OTHER | P713649 | 01 | PA | OXFORD | OTHER | 485897 | 01 | PA | AETNA US HEALTHCARE | OTHER | 20008705 | 01 | PA | AMERIHEALTH MERCY MA | OTHER | 4005656 | 01 | PA | CIGNA PA | OTHER | 1951701 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 597435 | 01 | PA | HIGHMARK BLUE SHIELD PA | OTHER |