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JOHN COSTELLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
(603) 893-8886

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
217260
MA
2080P0202X
Pediatric Cardiology Physician
52686
SC
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
52686
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2014416
MA
01
25-01706
UNITED HEALTHCARE MA
MA
01
26528
BMC HEALTHNET
MA
01
32292
NEIGHBORHOOD HEALTH PLAN
MA
01
3253447
AETNA MA
MA
01
97288001
NETWORK HEALTH
MA
01
AA9211
HARVARD PILGRIM
MA
01
J26530
HMO BLUE
MA
05
JC51504
RI
01
TUFTS HEALTH PLAN
217260
MA
Enumeration date
10/31/2005
Last updated
02/18/2022
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