MEDICARE: JULIE LEE 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
1	207RP1001X	Pulmonary Disease Physician	35052049	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831144625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE LEE COSTELLO MD

Provider Business Mailing Address
First Line	:	5969 E BROAD ST
Second Line	:	SUITE 400
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1546
Country	:	US
Telephone Number	:	614-577-8322
Fax Number	:	614-577-8302

Provider Business Practice Location Address
First Line	:	5969 E BROAD ST
Second Line	:	SUITE 400
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1546
Country	:	US
Telephone Number	:	614-577-8322
Fax Number	:	614-577-8302

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	02/14/2013

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