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Individual

DR. AMY COSTELLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706-4821
(605) 385-3285
Mailing address
22839 GATEWAY RD, BOX ELDER, SD 57719
(605) 385-3285

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101234865
VA

Other

Enumeration date
05/04/2006
Last updated
06/08/2016
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