| Pamela J. Costello, Md, Pc | |
|
3915 Bristol Hwy Ste 103 Johnson City TN 37601-1400 | |
| (423) 461-0073 | |
| (423) 461-0076 |
| Full Name | Pamela J. Costello, Md, Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3915 Bristol Hwy Ste 103, Johnson City, Tennessee |
| Authorized Official Name and Position | Pamela J Costello (CEO) |
| Authorized Official Contact | 4234610073 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pamela J. Costello, Md, Pc 3915 Bristol Hwy Ste 103 Johnson City TN 37601-1400 Ph: (423) 461-0073 | Pamela J. Costello, Md, Pc 3915 Bristol Hwy Ste 103 Johnson City TN 37601-1400 Ph: (423) 461-0073 |
| NPI Number | 1942310149 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 11/08/2019 |
| Medicare PECOS PAC ID | 9830220714 |
|---|---|
| Medicare Enrollment ID | O20190701002298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942310149 | NPI | - | NPPES |
| Q05797A | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Pamela J Costello |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1457365876 PECOS PAC ID: 4880723022 Enrollment ID: I20190701002398 |
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