Individual
CAREY COSTANTINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL VILLAGE DR, INDEPENDENT ANESTHESIOLOGISTS PSC, EDGEWOOD, KY 41017-3403
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DR, INDEPENDENT ANESTHESIOLOGISTS PSC SUITE 258, EDGEWOOD, KY 41017-5401
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
24111
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000032801
ANTHEM BLUE SHIELD
—
05
—
0605063
—
OH
01
—
10813849
CAQH
—
05
—
200000640
—
IN
01
—
611077369
TAX ID
—
05
—
64241110
—
KY
Enumeration date
11/07/2005
Last updated
05/13/2010
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