MEDICARE: CARIANNA COSTON DO

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	207Q00000X	Family Medicine Physician	83153	SC

General Provider Information

NPI Number	:	1336761188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARIANNA COSTON DO

Provider Business Mailing Address
First Line	:	PO BOX 100174
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29202-3174
Country	:	US
Telephone Number	:	864-512-5955
Fax Number	:	864-512-5957

Provider Business Practice Location Address
First Line	:	3501 CLEMSON BLVD STE 1
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-1328
Country	:	US
Telephone Number	:	864-512-3452
Fax Number	:	684-512-3453

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

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	08/04/2023

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Directions to “ CARIANNA COSTON DO” Practice Location

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