Provider Demographics
NPI:1447259536
Name:ALLERGY AND ASTHMA ASSOCIATES - SOUTH, P.C.
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA ASSOCIATES - SOUTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-759-7555
Mailing Address - Street 1:33 COHASSET AVE
Mailing Address - Street 2:UNIT #2
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3270
Mailing Address - Country:US
Mailing Address - Phone:508-759-7555
Mailing Address - Fax:508-759-7355
Practice Address - Street 1:33 COHASSET AVE
Practice Address - Street 2:UNIT #2
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02532-3270
Practice Address - Country:US
Practice Address - Phone:508-759-7555
Practice Address - Fax:508-759-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00000207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty