Individual
DR. MICHAEL W COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22911 JEFFERSON BLVD, SMITHSBURG, MD 21783-1617
(301) 824-3343
Mailing address
22911 JEFFERSON BLVD, SMITHSBURG, MD 21783-1617
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0041378
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1621121
UNITED
—
05
—
168371300
—
MD
01
—
522924-09
CAREFIRST BCBS MARYLAND
—
01
—
W567-0012
CAREFIRST BCBS GHMSI
—
Enumeration date
01/26/2006
Last updated
01/25/2024
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