Individual
KATHLEEN M. COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.P.
Contact information
Practice address
600 N WOLFE ST, PATHOLOGY BLDG - RM 625, BALTIMORE, MD 21287-0005
(410) 614-1066
(410) 502-6736
Mailing address
PO BOX 64227, BALTIMORE, MD 21264-4227
(410) 410-9331
(410) 502-6736
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R069246
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400003000
—
MD
Enumeration date
04/23/2007
Last updated
05/20/2011
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