Organization · Type 2 NPI

Jack M. Costa, M.d., P.c.

Specialist · Fairfax, VA

NPI number 1972808335 Active

Practice location

3650 Joseph Siewick Dr, Suite 202
Fairfax, VA 22033-1710

Call (703) 391-2516 Map

Fax (703) 476-8244

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000X0101028288 (VA)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1972808335

Jack M. Costa, M.d., P.c.'s National Provider Identifier is 1972808335, issued on Jan 17, 2011. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Fairfax, VA. The record was last updated on Jan 17, 2011.