Provider Demographics
NPI:1770859191
Name:COSTER, JENALEE NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENALEE
Middle Name:NICOLE
Last Name:COSTER
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:PO BOX 639969
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5855 BREMO RD STE 506
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1925
Practice Address - Country:US
Practice Address - Phone:804-287-7929
Practice Address - Fax:804-281-8372
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474782208G00000X
CAA131322208600000X, 208G00000X
VA0101280632208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery