Individual
MR. EDWARD T COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1002 SCHNEIDER DR, SUITE 104, MALVERN, AR 72104-4816
(501) 332-7981
(501) 337-9964
Mailing address
1002 SCHNEIDER DR, SUITE 104, MALVERN, AR 72104-4816
(501) 332-7981
(501) 337-9964
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-251
AR
Other
Enumeration date
07/13/2006
Last updated
05/17/2021
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