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General NPI Number Information
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NPI Number | 1396055471
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Entity Type | Individual
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Provider Name | LINDA M COSTELLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 2141 K ST NW SUITE 500
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City | WASHINGTON
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State | DC
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Zip | 20037-1810
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Country | US
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Telephone | 202-994-6827
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Fax |
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Provider Business Mailing Address
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Address Line | 2141 K ST NW SUITE 500
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City | WASHINGTON
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State | DC
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Zip | 20037-1810
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Country | US
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Telephone | 202-994-6827
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA30037
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110840738
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0003131
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License Number State | MD
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