Provider Demographics
NPI:1710936455
Name:COSTELLO, RICHARD FREDERICK II (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:COSTELLO
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2224 NW 50TH ST
Mailing Address - Street 2:SUITE 276W
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8046
Mailing Address - Country:US
Mailing Address - Phone:405-858-2350
Mailing Address - Fax:405-858-2365
Practice Address - Street 1:2224 NW 50TH ST
Practice Address - Street 2:SUITE 276W
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8046
Practice Address - Country:US
Practice Address - Phone:405-858-2350
Practice Address - Fax:405-858-2365
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK038442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00379874OtherRAILROAD MEDICARE
OKP00388318OtherRAILROAD MEDICARE
OK200075870AMedicaid
OKP00369403OtherRAILROAD MEDICARE
OKP00427829OtherRAILROAD MEDICARE
OK24C726806Medicare PIN
OKP00388318OtherRAILROAD MEDICARE
OK24C726805Medicare PIN
OKP00369403OtherRAILROAD MEDICARE
OK242706603Medicare PIN
OKP00379874OtherRAILROAD MEDICARE
OKOK700296Medicare PIN
OKOKAAA2768Medicare PIN
OKP00392447Medicare PIN
OK246713601Medicare PIN
OK249728208Medicare PIN