Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 13107 | NH |
NPI | 1033144084 |
---|---|
Provider Name | Dominica Catherine Costello |
First Address | Amesbury, MA 01913-2150 |
Second Address | Amesbury, MA 01913-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30224598 | (05) | NH |
432470999 | (05) | ME |
I71825 | (02) | NH |