MEDICARE: JOHN COSTELLO

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME178865	FL
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35146063	OH

General Provider Information

NPI Number	:	1952531212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN COSTELLO

Provider Business Mailing Address
First Line	:	2501 N ORANGE AVE STE 442
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4644
Country	:	US
Telephone Number	:	407-303-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N ORANGE AVE STE 442
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4644
Country	:	US
Telephone Number	:	407-303-2001
Fax Number	:

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

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	03/19/2026

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Directions to “ JOHN COSTELLO ” Practice Location

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