Individual
LISA MARIE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MPH
Contact information
Practice address
1 STADIUM DRIVE, MORGANTOWN, WV 26506
(304) 598-4000
Mailing address
1 STADIUM DRIVE, MORGANTOWN, WV 26506
(304) 598-4000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25300
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/16/2011
Last updated
04/15/2022
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