Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 286671 | MA |
NPI | 1497118756 |
---|---|
Provider Name | Timothy Costales |
First Address | North Potomac, MD 20878-4918 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2016 |
Last Update Date | 09/06/2021 |