Provider Demographics
NPI:1104657733
Name:COSTELLO, JOSEPH PATRICK II (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:COSTELLO
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 W SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2956
Mailing Address - Country:US
Mailing Address - Phone:605-610-7904
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD.
Practice Address - Street 2:MEB-SUITE 157 - ATTN: INSTITUTIONAL COORDINATOR
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203
Practice Address - Country:US
Practice Address - Phone:605-610-7904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program