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NPI Code Detail

MEDICARE: DR. MARY CATHERINE COSTELLO DO

MEDICARE:  DR. MARY CATHERINE COSTELLO  DO
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1831778695
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY CATHERINE COSTELLO DO
Provider Business Mailing Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number : 216-444-2200
Fax Number :
Provider Business Practice Location Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-2546
Country : US
Telephone Number : 216-444-4220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2021
Last Update Date : 06/06/2022

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Directions to “ DR. MARY CATHERINE COSTELLO DO” Practice Location

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