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General NPI Number Information
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NPI Number | 1821625542
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Entity Type | Individual
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Provider Name | WILLIAM ARTHUR COSTELLO JR. DO
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Gender | Male
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 15310 AMBERLY DR
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City | TAMPA
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State | FL
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Zip | 33647-2199
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Country | US
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Telephone | 813-907-0123
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Fax | 813-907-5559
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Provider Business Mailing Address
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Address Line | 15310 AMBERLY DR
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City | TAMPA
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State | FL
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Zip | 33647-2199
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Country | US
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Telephone | 813-907-0123
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Fax | 813-907-5559
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS0019812
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License Number State | FL
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