Provider Demographics
NPI:1720362254
Name:COSTABILE, JAMES CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:COSTABILE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:14090 HG TRUEMAN RD STE 2100
Mailing Address - Street 2:
Mailing Address - City:SOLOMONS
Mailing Address - State:MD
Mailing Address - Zip Code:20688-3151
Mailing Address - Country:US
Mailing Address - Phone:410-394-3712
Mailing Address - Fax:410-394-3714
Practice Address - Street 1:14090 HG TRUEMAN RD STE 2100
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-3151
Practice Address - Country:US
Practice Address - Phone:410-394-3712
Practice Address - Fax:410-394-3714
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2024-01-16
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Provider Licenses
StateLicense IDTaxonomies
PAOA002808363AM0700X
PAMA056078363AM0700X
MDC06816363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical