Individual
PAMELA J COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3915 BRISTOL HWY STE 301, JOHNSON CITY, TN 37601-1403
(423) 461-0073
(234) 610-0764
Mailing address
3915 BRISTOL HWY STE 103, JOHNSON CITY, TN 37601-1400
(423) 461-0073
(423) 461-0076
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD0000056597
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q050671
—
TN
Enumeration date
07/28/2006
Last updated
10/25/2019
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