Individual
ANN R COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
217 N AURORA ST, ITHACA, NY 14850-4345
(607) 273-2811
(607) 273-1170
Mailing address
217 N AURORA ST, ITHACA, NY 14850-4345
(607) 273-2811
(607) 273-1170
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
149866
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
149866
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000910796001
HEALTHNOW
NY
05
—
00715215
—
NY
01
—
4217986
AETNA
NY
Enumeration date
09/21/2005
Last updated
01/24/2024
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