Healthcare Provider Details

I. General information

NPI: 1437470481
Provider Name (Legal Business Name): ADRIENNE MARIE O'NEILL D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIENNE MARIE COSTELLO D.P.M.

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MICHIGAN ST
SIDNEY OH
45365-2404
US

IV. Provider business mailing address

1000 MICHIGAN ST
SIDNEY OH
45365-2404
US

V. Phone/Fax

Practice location:
  • Phone: 937-493-4659
  • Fax: 937-492-6557
Mailing address:
  • Phone: 937-493-4659
  • Fax: 937-492-6557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number59.000277
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003604
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: