Individual
DR. PATRICK NICHOLAS COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-6389
(423) 431-6331
Mailing address
PO BOX 52990, GREENWOOD, SC 29649-0048
(864) 223-3600
(864) 223-6054
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD31483
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3141925
BCBS
TN
05
—
3849073
—
TN
05
—
64011265
—
KY
05
—
6600018
—
VA
Enumeration date
02/18/2006
Last updated
02/18/2008
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