Mary Marcelle Costantino (NPI# 1407951171, PAC ID# 4688670847) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERVENTIONAL RADIOLOGY.
| Nation Provider ID (NPI) | 1407951171 |
| PAC ID by PECOS | 4688670847 |
| Professional Enrollment ID | I20061011000149 |
| Full Name | Mary Marcelle Costantino |
| Organization Legal Name | COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC |
| Address |
6958 Sw Varns St Portland OR 97223-8281 |
| Phone Number | 5036837730 |
| Gender | F |
| Credential | MD |
| Medical School | UNIVERSITY OF CALIFORNIA, UCLA SCHOOL OF MEDICINE |
| Graduation Year | 2001 |
| Primary Specialty | INTERVENTIONAL RADIOLOGY |
| Group Practice PAC ID | 7810125267 |
| Number of Group Practice Members | 21 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 380071 | WILLAMETTE VALLEY MEDICAL CENTER |
| 380004 | PROVIDENCE ST VINCENT MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2301 N 4th St, Flagstaff, AZ 86004-3708 | 9287197400 | COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC |
| 4001 E Baseline Rd, Suite 107, Gilbert, AZ 85234-2744 | 4803747354 | COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC |
| 6958 Sw Varns St, Portland, OR 97223-8281 | 5036837730 | COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC |
| 4624 S Holladay Blvd, Suite 202, Salt Lake City, UT 84117-7168 | 4803747250 | COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC |
| Organization Legal Name | COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC |
| Physicians | 12 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joshua Thomas Cady | Podiatry | Comprehensive Interventional Care Centers, Pllc | 4001 E Baseline Rd, Suite 107, Gilbert, AZ 85234-2744 |
| Jeffrey M Braxton | General Surgery | Comprehensive Interventional Care Centers, Pllc | 6301 S Mcclintock Dr, Suite 115, Tempe, AZ 85283-3393 |
| Kerry Zang | Podiatry | Comprehensive Interventional Care Centers, Pllc | 14642 N Del Webb Blvd, Suite 200, Sun City, AZ 85351-2102 |
| Hassan S Makki | Interventional Cardiology | Comprehensive Interventional Care Centers, Pllc | 2301 N 4th St, Flagstaff, AZ 86004-3708 |
| Shahram Askari | Podiatry | Comprehensive Interventional Care Centers, Pllc | 10555 N Tatum Blvd, Suite A101, Paradise Valley, AZ 85253-1096 |
| Melvin L Bottner | Family Medicine | Comprehensive Interventional Care Centers, Pllc | 130 S 63rd St, Suite 101, Mesa, AZ 85206-1620 |
| Daniel S Schulman | Podiatry | Comprehensive Interventional Care Centers, Pllc | 6301 S Mcclintock Dr, Suite 115, Tempe, AZ 85283-3393 |
| James R Mceown | Emergency Medicine | Comprehensive Interventional Care Centers, Pllc | 6301 S Mcclintock Dr, Suite 115, Tempe, AZ 85283-3393 |
| Michael C Switzer | Diagnostic Radiology | Comprehensive Interventional Care Centers, Pllc | 4001 E Baseline Rd, Suite 107, Gilbert, AZ 85234-2744 |
| Mathew Benjamin | Internal Medicine | Comprehensive Interventional Care Centers, Pllc | 130 S 63rd St, Suite 101, Mesa, AZ 85206-1620 |
| Street Address |
6958 SW VARNS ST |
| City | PORTLAND |
| State | OR |
| Zip | 97223-8281 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Quincy Michael Shorthill | Physical Therapy | 8915 Swnordic Dr, Tigard, OR 97223 | |
| Robert L Marrs | Clinical Social Worker | 7175 Sw Beveland St, Suite 200, Tigard, OR 97223 | |
| Halsy J Carter | Chiropractic | 12700 Sw N Dakota St, 180 Straight Up Chiropractic, Tigard, OR 97223-0802 | |
| Heidi U Ferguson | Family Medicine | Providence Health and Services Oregon | 12442 Sw Scholls Ferry Rd, Suite 100, Tigard, OR 97223-0803 |
| Evagelia Baros | Internal Medicine | Providence Health and Services Oregon | 12442 Sw Scholls Ferry, Rd Suite 106, Tigard, OR 97223-0803 |
| Yvonne Howell | Physician Assistant | Providence Health and Services Oregon | 12442 Sw Scholls Ferry, Rd Suite 106, Tigard, OR 97223-0803 |
| Raghuveer B Shenoy | Internal Medicine | Providence Health and Services Oregon | 12442 Sw Scholls Ferry, Rd Suite 106, Tigard, OR 97223-0803 |
| Kathryn Marie Lund | Nurse Practitioner | Providence Health and Services Oregon | 12442 Sw Scholls Ferry, Rd Suite 106, Tigard, OR 97223-0803 |
| Kevin A Brooks | Physician Assistant | Providence Health and Services Oregon | 12442 Sw Scholls Ferry, Rd Suite 106, Tigard, OR 97223-0803 |
| Kirsten A Holmes | Physician Assistant | Providence Health and Services Oregon | 12442 Sw Scholls Ferry, Rd Suite 106, Tigard, OR 97223-0803 |
| Find all physicians in zip 97223 | |||
| City | PORTLAND |
| Zip Code | 97223 |
| Specialty | INTERVENTIONAL RADIOLOGY |
| City + Specialty | PORTLAND + INTERVENTIONAL RADIOLOGY |
Please comment or provide details below to improve the information on Mary Marcelle Costantino.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.