Provider Demographics
NPI:1639163785
Name:COSTELLO, BETTINA M (MD)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:M
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054
Mailing Address - Country:US
Mailing Address - Phone:603-882-2941
Mailing Address - Fax:603-429-1844
Practice Address - Street 1:7 EXECUTIVE PARK DRIVE
Practice Address - Street 2:HOME HEALTH & HOSPICE CARE
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054
Practice Address - Country:US
Practice Address - Phone:603-882-2941
Practice Address - Fax:603-429-1844
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11620207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3080246Medicaid
NH3080246Medicaid
H59935Medicare UPIN