Cynthia Lou Costenbader, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101036748 Issued in VA

Practice address

8136 Old Keene Mill Rd Ste A309
Springfield, VA 22152-1853

Phone

(703) 569-8021

Fax

(703) 569-8123

NPI assigned

May 8, 2007

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Allergy Care Centers of Virginia Inc

  • Allergy Physician
  • Vienna, VA
  • NPI 1740228741
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 3, 2022.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1295948933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT. 453 PO BOX 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480001",
            "telephone_number": "828-575-2625",
            "fax_number": "828-350-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8136 OLD KEENE MILL RD STE A309",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221521853",
            "telephone_number": "703-569-8021",
            "fax_number": "703-569-8123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTENBADER",
        "first_name": "CYNTHIA",
        "middle_name": "LOU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-08",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101036748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "799347100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295948933",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "231477ZRGM",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karicia Corum, LCSW
• Samantha Costanzo, MSOTR/L
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Judith R. Coulter, D.M.D.
• Latesha Shinese Coulter, BCBA
• Gina G Courtney, MD
• Loretta M Cowdrill, NP
• Katherine Craig

• All providers in Springfield, VA
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.