Provider Demographics
NPI:1366438756
Name:COSTIGAN, PAUL M (CRNA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:COSTIGAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3919
Mailing Address - Country:US
Mailing Address - Phone:401-274-8110
Mailing Address - Fax:401-861-5220
Practice Address - Street 1:101 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2401
Practice Address - Country:US
Practice Address - Phone:401-274-8110
Practice Address - Fax:401-861-5220
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00809367500000X
RIRNA22316367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI07057330Medicare ID - Type Unspecified