Healthcare Provider Details

I. General information

NPI: 1174563688
Provider Name (Legal Business Name): BRIAN A COSTELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 CENTRAL PARK BLVD N SUITE 207
BOCA RATON FL
33428-2231
US

IV. Provider business mailing address

9970 CENTRAL PARK BLVD N SUITE 207
BOCA RATON FL
33428-2231
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-1027
  • Fax: 561-482-1028
Mailing address:
  • Phone: 561-482-1027
  • Fax: 561-482-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME90900
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberME90900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: