MEDICARE: MR. JAMES CHRISTOPHER COSTABILE PA-C

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
1	363A00000X	Physician Assistant	0110011169	VA
2	363AM0700X	Medical Physician Assistant	C06816	MD

General Provider Information

NPI Number	:	1720362254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES CHRISTOPHER COSTABILE PA-C

Provider Business Mailing Address
First Line	:	18024 FOREST RD
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-4853
Country	:	US
Telephone Number	:	434-214-0722
Fax Number	:	434-288-1211

Provider Business Practice Location Address
First Line	:	14090 HG TRUEMAN RD STE 2100
Second Line	:
City	:	SOLOMONS
State	:	MD
Zip	:	20688-3151
Country	:	US
Telephone Number	:	410-394-3712
Fax Number	:	410-394-3714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	01/30/2026

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