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NPI Code Detail

MEDICARE: DR. CLIFFORD COSTELLO D.O.

MEDICARE: DR. CLIFFORD 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
1208000000XPediatrics PhysicianDR0063863CO

General Provider Information

NPI Number : 1417483959
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLIFFORD COSTELLO D.O.
Provider Business Mailing Address
First Line : 50 N. DUNLAP
Second Line : PEDIATRIC RESIDENCY OFFICE
City : MEMPHIS
State : TN
Zip : 38103
Country : US
Telephone Number : 901-287-6756
Fax Number :
Provider Business Practice Location Address
First Line : 1830 N FRANKLIN ST STE 500
Second Line :
City : DENVER
State : CO
Zip : 80218-1169
Country : US
Telephone Number : 303-825-8584
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2017
Last Update Date : 12/13/2023

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