Individual
JUSTINE KOSTRUB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
720 BLACKBURN RD FL 1, SEWICKLEY, PA 15143-1459
(412) 741-0985
(412) 749-6785
Mailing address
720 BLACKBURN RD., 1ST FLOOR, SEWICKLEY, PA 15143
(412) 741-0985
(412) 749-6785
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD461424
PA
390200000X
Student in an Organized Health Care Education/Training Program
MT-207188
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103147653
—
PA
Enumeration date
06/04/2014
Last updated
07/10/2017
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