MEDICARE: BETTINA M COSTELLO MD

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	207V00000X	Obstetrics & Gynecology Physician	11620	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639163785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTINA M COSTELLO MD

Provider Business Mailing Address
First Line	:	7 EXECUTIVE PARK DRIVE
Second Line	:
City	:	MERRIMACK
State	:	NH
Zip	:	03054
Country	:	US
Telephone Number	:	603-882-2941
Fax Number	:	603-429-1844

Provider Business Practice Location Address
First Line	:	7 EXECUTIVE PARK DRIVE
Second Line	:	HOME HEALTH & HOSPICE CARE
City	:	MERRIMACK
State	:	NH
Zip	:	03054
Country	:	US
Telephone Number	:	603-882-2941
Fax Number	:	603-429-1844

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	11/23/2015

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