Jack Michael Costa in Fairfax - Dermatology
Jack Michael Costa - NPI 1144393935
Jack Michael Costa is a Dermatology in Fairfax, Virginia. Jack Michael Costa practices all healthcare services and medical treatments related to Dermatology. The NPI Number for Jack Michael Costa is 1144393935. The last update date is 2010-12-30.
Jack Michael Costa's current location address is 3650 Joseph Siewick Drive, Fairfax, Virginia. You can contact this provider via phone number 7033912516 and fax number 7034768244. The mailing address for Jack Michael Costa is 3650 Joseph Siewick Drive, Fairfax, Virginia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jack Michael Costa |
|---|---|
| Address | 3650 Joseph Siewick Drive, Fairfax, Virginia |
| Phone Number | 7033912516 |
| Fax Number | 7034768244 |
| Sole Proprietor | Y |
| Credentials | M.D. |
NPI Number Detail
| NPI Number | 1144393935 |
|---|---|
| Provider Enumeration Date | 2006-11-17 |
| Last Updated Date | 2010-12-30 |
Provider Mailing Address Detail
| Address | 3650 Joseph Siewick Drive |
|---|---|
| City | Fairfax |
| State | Virginia (VA) |
| Post Code | 22033 |
| Phone Number | 7033912516 |
| Fax Number | 7034768244 |
Provider's Primary Taxonomy Detail
| Speciality | Dermatology |
|---|---|
| Taxonomy | 207N00000X |
| Licence No | 101028288 |
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Definition: A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 9320 | VA | BLUE CROSS BLUE SHIELD | |
| 3539 | VA | ANTHEM |
Post Comment/ Review Below
What is the unique provider identifier assigned to Jack Michael Costa?
The Jack Michael Costa has been issued the NPI (National Provider Identifier) 1144393935 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code is a unique identification number for healthcare providers.
Could you please share the complete physical location address where Jack Michael Costa's facilities are situated?
The facilities of Jack Michael Costa are physically located at the following address: 3650 Joseph Siewick Drive, Fairfax, VA, 22033.
What is the Jack Michael Costa's specialty and taxonomy code?
The Jack Michael Costa's specialty is Dermatology, and the corresponding taxonomy code is 207N00000X.
On what date did the Centers for Medicare & Medicaid Services issue the 1144393935 to Jack Michael Costa?
The Jack Michael Costa received its 1144393935 assignment from the Centers for Medicare & Medicaid Services on 2006-11-17.
As of what date were the details pertaining to Jack Michael Costa last refreshed?
The information related to the Jack Michael Costa, including its address, specialty, and other relevant details, was last updated on 2010-12-30.