MEDICARE: DR. BRIAN A COSTELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	ME90900	FL
2	2084E0001X	Epilepsy Physician	ME90900	FL

General Provider Information

NPI Number	:	1174563688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN A COSTELL M.D.

Provider Business Mailing Address
First Line	:	9970 CENTRAL PARK BLVD N
Second Line	:	SUITE 207
City	:	BOCA RATON
State	:	FL
Zip	:	33428-2231
Country	:	US
Telephone Number	:	561-482-1027
Fax Number	:	561-482-1028

Provider Business Practice Location Address
First Line	:	9970 CENTRAL PARK BLVD N
Second Line	:	SUITE 207
City	:	BOCA RATON
State	:	FL
Zip	:	33428-2231
Country	:	US
Telephone Number	:	561-482-1027
Fax Number	:	561-482-1028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	06/12/2025

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