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NPI Code Detail

MEDICARE: DR. JENNIFER ANN COSTELLO D.O.

MEDICARE: DR. JENNIFER ANN COSTELLO D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician1393NE
22084P0804XChild & Adolescent Psychiatry PhysicianH0091257MD

General Provider Information

NPI Number : 1205251139
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER ANN COSTELLO D.O.
Provider Business Mailing Address
First Line : 14612 STURTEVANT RD
Second Line :
City : SILVER SPRING
State : MD
Zip : 20905-4455
Country : US
Telephone Number : 540-290-6889
Fax Number :
Provider Business Practice Location Address
First Line : 4350 E WEST HWY STE 200
Second Line :
City : BETHESDA
State : MD
Zip : 20814-4426
Country : US
Telephone Number : 301-970-4001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2014
Last Update Date : 04/19/2021

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