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NPI Code Detail

MEDICARE: DAVID M COSTELLO P.A. - C

MEDICARE: DAVID M COSTELLO P.A. - C
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
1363A00000XPhysician AssistantPA2227FL

Other Identifiers

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

General Provider Information

NPI Number : 1972588408
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID M COSTELLO P.A. - C
Provider Business Mailing Address
First Line : 1285 ORANGE AVE
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-4984
Country : US
Telephone Number : 407-599-3710
Fax Number : 407-643-2807
Provider Business Practice Location Address
First Line : 1285 ORANGE AVE
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-4984
Country : US
Telephone Number : 407-599-3710
Fax Number : 407-643-2807
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 11/24/2020

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