Individual
BENJAMIN COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3101 WASHINGTON AVE, NEWPORT NEWS, VA 23607-3328
(757) 812-0662
Mailing address
3000 COLISEUM DR, HAMPTON, VA 23666-5963
(757) 736-1000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126003965
VA
Other
Enumeration date
01/14/2025
Last updated
01/14/2025
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