Costello, Pamela J

Costello, Pamela J is an individual health care provider with primary practice located at 3915 Bristol Hwy Ste 301 , Johnson City TN 37601-1403. She recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as her primary health care specialty. Costello, Pamela J can be contacted via phone (423) 461-0073.

Contact Information

Primary practice address
3915 Bristol Hwy Ste 301 Johnson City TN 37601-1403
Phone: (423) 461-0073
Fax: (234) 610-0764
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X MD0000056597 Tennessee

Profile Details

NPI number 1457365876
LBN Legal business name Costello, Pamela J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2006
Last updated Oct 25th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457365876 NPPES
Tennessee MEDICAID Q050671

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