| NPI | 1871589861 |
|---|---|
| Former Legal Business Name | THEODORE G. COSTICH, MD |
| Entity Type | Organization |
| Authorized Contact | THEODORE GERARD COSTICH Owner 716-631-1045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 187420) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NY 187420) |
| Enumeration Date | 2005-09-25 |
| Last Update Date | 2020-08-22 |