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General NPI Number Information
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NPI Number | 1831144625
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Entity Type | Individual
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Provider Name | JULIE LEE COSTELLO MD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 5969 E BROAD ST SUITE 400
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City | COLUMBUS
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State | OH
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Zip | 43213-1546
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Country | US
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Telephone | 614-577-8322
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Fax | 614-577-8302
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Provider Business Mailing Address
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Address Line | 5969 E BROAD ST SUITE 400
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City | COLUMBUS
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State | OH
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Zip | 43213-1546
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Country | US
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Telephone | 614-577-8322
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Fax | 614-577-8302
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 35052049
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License Number State | OH
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