Healthcare Provider Details

I. General information

NPI: 1194986554
Provider Name (Legal Business Name): CARRIE ELIZABETH COSTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE ELIZABETH TUTEN MD

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-6633
  • Fax: 330-543-7649
Mailing address:
  • Phone: 330-543-6633
  • Fax: 330-543-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number35.094556
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: