Provider Demographics
NPI:1952345670
Name:COSTELLO, NORA ANNE (PT)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:ANNE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 VETERANS HIGHWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056
Mailing Address - Country:US
Mailing Address - Phone:215-752-4553
Mailing Address - Fax:215-752-0703
Practice Address - Street 1:1400 VETERANS HIGHWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056
Practice Address - Country:US
Practice Address - Phone:215-752-4553
Practice Address - Fax:215-752-0703
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017037174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053616OtherAETNA
PA2319729000OtherINDEPENDENCE BLUE CROSS
PA083837JUWMedicare ID - Type Unspecified