Individual
CHENCHEN COSTELLOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-3138
(540) 982-2719
Mailing address
PO BOX 535392, ATLANTA, GA 30353-5321
(919) 882-7908
(919) 873-9821
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101271962
VA
207L00000X
Anesthesiology Physician
279691
MA
208VP0014X
Interventional Pain Medicine Physician
0101271962
VA
Other
Enumeration date
04/26/2016
Last updated
06/20/2022
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