Individual
JONAH MARCEL COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4881 SUGAR MAPLE DR, DAYTON, OH 45433-5529
(937) 257-9926
Mailing address
4881 SUGAR MAPLE DR, DAYTON, OH 45433-5529
(937) 257-9926
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
208D00000X
General Practice Physician
Primary
82122-21
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Enumeration date
04/01/2024
Last updated
04/18/2026
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