Mark John Costantino, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

15361 Issued in GA

Practice address

195 King Ave
Athens, GA 30606-2963

Phone

(706) 549-8306

Fax

(706) 549-8351

NPI assigned

Oct 4, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University Surgical Associates of Athens

  • Specialist
  • Watkinsville, GA
  • NPI 1861500183

  Vascular Surgery

  Medicare reassignment NPD
• St. Mary'S Hospital, Inc.

  • General Acute Care Hospital
  • Athens, GA
  • NPI 1871556621
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317168000000",
    "number": "1447247523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 KING AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062963",
            "telephone_number": "706-549-8306",
            "fax_number": "706-549-8351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 KING AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062963",
            "telephone_number": "706-549-8306",
            "fax_number": "706-549-8351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTANTINO",
        "first_name": "MARK",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2011-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "15361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hazael Jane Cortese, RN
• Vito Cortese Jr., RN
• Cosmetic and Restorative Dentistry
• Carlos Miguel Cossio, MD
• Charles Phillip Costa, MAPC
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Timothy Costyn, PHARMD
• Lucia F Cotten, MD

• Vascular Surgery Physician in Athens, GA
• Providers in Athens, GA by specialty
• Vascular Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.