Active NPI
Mirjana G Kostich, M.D.
- Pediatrics Physician
- East Boston, MA
National Provider Identifier
1740269315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 50448
- Practice address
- 10 Gove St
East Boston, MA 02128-1920 - Phone
- (617) 569-5800
- Fax
- (617) 568-4780
- NPI assigned
- Jan 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 50448 | MA | Primary |
Addresses
Primary practice location
10 Gove St
East Boston, MA 02128-1920
Mailing address
10 Gove St
East Boston, MA 02128-1920
Phone (617) 569-5800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3002675 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50448 | MA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1740269315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 GOVE ST",
"city": "EAST BOSTON",
"state": "MA",
"postal_code": "021281920",
"telephone_number": "617-569-5800",
"fax_number": "617-568-4780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 GOVE ST",
"city": "EAST BOSTON",
"state": "MA",
"postal_code": "021281920",
"telephone_number": "617-569-5800",
"fax_number": "617-568-4780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSTICH",
"first_name": "MIRJANA",
"middle_name": "G",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-12",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "50448",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3002675",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.