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General NPI Number Information
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NPI Number | 1609856798
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Entity Type | Individual
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Provider Name | KATHRYN COSTELLO ADAMS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14450 SMOKETOWN RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4712
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Country | US
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Telephone | 703-576-1419
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Fax | 703-576-1414
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Provider Business Mailing Address
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Address Line | 17567 WAYSIDE DR
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City | DUMFRIES
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State | VA
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Zip | 22026-4513
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Country | US
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Telephone | 703-221-4776
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Fax | 703-576-1414
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0110001270
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License Number State | VA
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