Healthcare Provider Details

I. General information

NPI: 1609856798
Provider Name (Legal Business Name): KATHRYN COSTELLO ADAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN LILLIAN COSTELLO PA-C

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W CORK ST STE 290
WINCHESTER VA
22601-3870
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 320
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-5404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001270
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: