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General NPI Number Information
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NPI Number | 1043640592
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Entity Type | Individual
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Provider Name | ALEXANDRA DEANNE COSTLOW AUD
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Gender | Female
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 925 CHESTNUT STREET 6TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4201
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Country | US
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Telephone | 215-955-6760
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Fax | 215-503-3736
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Provider Business Mailing Address
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Address Line | 925 CHESTNUT STREET 6TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4201
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Country | US
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Telephone | 215-955-6760
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Fax | 215-503-3736
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AT006318
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License Number State | PA
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