Provider Demographics
NPI:1154306454
Name:COSTELLO, BRIAN L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:COSTELLO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5310 HOMESTEAD RD NE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1437
Mailing Address - Country:US
Mailing Address - Phone:505-872-4700
Mailing Address - Fax:505-872-4709
Practice Address - Street 1:5310 HOMESTEAD RD NE
Practice Address - Street 2:SUITE 301
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1437
Practice Address - Country:US
Practice Address - Phone:505-872-4700
Practice Address - Fax:505-872-4709
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2016-09-26
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical