Organization
PAMELA J. COSTELLO, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAMELA J COSTELLO MD (CEO)
(423) 461-0073
Entity
Organization
Contact information
Practice address
3915 BRISTOL HWY STE 103, JOHNSON CITY, TN 37601-1400
(423) 461-0073
(423) 461-0076
Mailing address
3915 BRISTOL HWY STE 103, JOHNSON CITY, TN 37601-1400
(423) 461-0073
(423) 461-0076
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q05797A
—
TN
Enumeration date
08/30/2006
Last updated
11/08/2019
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