Provider Demographics
NPI:1588877435
Name:D'COSTA, QUEENIE MOUSUMI (MD)
Entity type:Individual
Prefix:
First Name:QUEENIE
Middle Name:MOUSUMI
Last Name:D'COSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:FORBES TOWER SUITE 9055
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-647-3087
Mailing Address - Fax:412-647-4486
Practice Address - Street 1:3705 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2584
Practice Address - Country:US
Practice Address - Phone:412-692-5164
Practice Address - Fax:412-692-6076
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP14512080P0203X
PAMD4243522080P0203X
FLME1027262080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000383900Medicaid
FLGU095ZMedicare PIN