Individual
DR. MARK STEVEN COSTELLO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
169 ASHLEY AVE, ROOM 202 MAIN HOSPITAL MSC333, CHARLESTON, SC 29425-8905
(843) 792-8299
Mailing address
169 ASHLEY AVE, ROOM 202 MAIN HOSPITAL MSC333, CHARLESTON, SC 29425-8905
(843) 792-8299
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MMD.39504 LL
SC
Other
Enumeration date
05/31/2016
Last updated
05/31/2016
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