Healthcare Provider Details

I. General information

NPI: 1215170204
Provider Name (Legal Business Name): KEVIN FRANCIS COSTELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 EMERALD PL STE 201
GREENVILLE NC
27834-5743
US

IV. Provider business mailing address

2430 EMERALD PL STE 201
GREENVILLE NC
27834-5743
US

V. Phone/Fax

Practice location:
  • Phone: 704-862-4700
  • Fax: 704-862-4749
Mailing address:
  • Phone: 704-862-4700
  • Fax: 704-862-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101256526
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2016-01841
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: