Provider Demographics
NPI:1316914047
Name:COSTA, MARCO A (MD)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:A
Last Name:COSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6295
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMFC1413207RC0000X
OH81-000076207RC0000X
OH81-000083207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000539190OtherANTHEM
GA000916022AMedicaid
OH7378305OtherAETNA
FL060068212OtherRAILROAD MEDICARE
OHP00454327OtherRAILROAD MEDICARE
FL2621908-00Medicaid
OH414956OtherWELLCARE
OH000000225199OtherUNISON
OH2770774Medicaid
OH751122OtherBUCKEYE
OHCO4218962Medicare PIN
FL2621908-00Medicaid
OHCO4218961Medicare PIN
OHP00454327OtherRAILROAD MEDICARE