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General NPI Number Information
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NPI Number | 1659570331
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Entity Type | Individual
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Provider Name | THOMAS P COSTELLO D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 03/30/2025
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Provider Practice Location Address
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Address Line | 2710 NE 18TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33305-3606
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Country | US
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Telephone | 267-884-3858
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 NE 18TH ST STE A
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City | FORT LAUDERDALE
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State | FL
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Zip | 33305-3606
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Country | US
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Telephone | 267-884-3858
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | OS6729
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | OS005840L
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License Number State | PA
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