Individual
DR. CYNTHIA LOU COSTENBADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8136 OLD KEENE MILL RD STE A309, SPRINGFIELD, VA 22152-1853
(703) 569-8021
(703) 569-8123
Mailing address
DEPT. 453 PO BOX 1000, MEMPHIS, TN 38148-0001
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101036748
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295948933
—
DC
01
—
231477ZRGM
MEDICARE PTAN
DC
05
—
799347100
—
MD
Enumeration date
05/08/2007
Last updated
05/03/2022
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