Provider Demographics
NPI:1033144084
Name:COSTELLO, DOMINICA CATHERINE (DO)
Entity type:Individual
Prefix:
First Name:DOMINICA
Middle Name:CATHERINE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HAVERHILL RD STE 505
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2150
Mailing Address - Country:US
Mailing Address - Phone:978-473-3221
Mailing Address - Fax:833-629-0822
Practice Address - Street 1:110 HAVERHILL RD STE 505
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2150
Practice Address - Country:US
Practice Address - Phone:978-473-3221
Practice Address - Fax:833-629-0822
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13107207RE0101X
MA220100207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30224598Medicaid
ME432470999Medicaid
NH30224598Medicaid
ME432470999Medicaid
P00407307Medicare PIN