Individual
DEANNE E WILSON-COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
(216) 286-6341
Mailing address
3605 WARRENSVILLE CENTER RD, SHAKER HTS, OH 44122-5203
(216) 286-6299
(216) 286-6341
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
35-067001
OH
207LP3000X
Pediatric Anesthesiology Physician
35-067001
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
35-067001
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000027353
ANTHEM
OH
01
—
000000221190
UINISON
OH
01
—
000000526173
ANTHEM
OH
05
—
0019347280001
—
PA
01
—
0187444
BCMH
OH
05
—
0187444
—
OH
01
—
0658025
AETNA
OH
01
—
1019347280001
PENNSLYVANIA MEDICAID
PA
01
—
364141
WELLCARE
OH
01
—
745987
BUCKEYE
OH
Enumeration date
07/20/2006
Last updated
06/12/2009
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