Provider Demographics
NPI:1275664450
Name:COSTLOW, EDWARD P (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:COSTLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:P
Other - Last Name:COSTLOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA MD
Mailing Address - Street 1:10 GERARD AVE
Mailing Address - Street 2:214
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3206
Mailing Address - Country:US
Mailing Address - Phone:410-561-1585
Mailing Address - Fax:410-252-0814
Practice Address - Street 1:10 GERARD AVE
Practice Address - Street 2:214
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3206
Practice Address - Country:US
Practice Address - Phone:410-561-1585
Practice Address - Fax:410-252-0814
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD19503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
41227801OtherBLUE SHIELD
409013902OtherRAILROAD MEDICARE
D74585Medicare UPIN
2467EP11Medicare ID - Type Unspecified