| Doctor Name: | DR. TIMOTHY D COSTELLO |
| NPI Number: | 1235195785 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 0101236812 |
| Business Practice Address: | 620 North Main Harrison, AR - 726012926 |
| Business Phone Number: | 8703652000 |
| Business Fax Number: | |
| Mailing Address: | 2080 Child St, JACKSONVILLE |
| State: | FL |
| Postal Code: | 322145005 |
| Phone Number: | 9045423500 |
| Fax Number: | |
| NPI Enumeration Date: | 04/25/2006 |
| NPI Last Update Date: | 05/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101236812 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |