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NPI Code Detail

MEDICARE: THOMAS H COSTELLO MD

MEDICARE: THOMAS H COSTELLO MD
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
1207Y00000XOtolaryngology Physician466552MA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M12237OTHERMAMEDICARE GROUP

General Provider Information

NPI Number : 1710986781
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS H COSTELLO MD
Provider Business Mailing Address
First Line : 100 TRADECENTER
Second Line : SUITE 750
City : WOBURN
State : MA
Zip : 01801-1851
Country : US
Telephone Number : 781-937-3001
Fax Number : 781-937-3070
Provider Business Practice Location Address
First Line : 100 TRADECENTER
Second Line : SUITE 750
City : WOBURN
State : MA
Zip : 01801-1851
Country : US
Telephone Number : 781-937-3001
Fax Number : 781-937-3070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 02/25/2014

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Directions to “ THOMAS H COSTELLO MD” Practice Location

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