Individual
DR. PAUL MCLANE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
89 MAIN ST, ESSEX JCT, VT 05452-3207
(802) 879-6556
(802) 872-8021
Mailing address
89 MAIN ST, ESSEX JCT, VT 05452-3207
(802) 879-6556
(802) 872-8021
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
42-0006459
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5629
—
VT
Enumeration date
10/10/2005
Last updated
10/11/2011
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