Jack Michael Costa, M.D.

NPI #1144393935 in Fairfax, Virginia

Provider Information

NPI Number
1144393935
Entity Type
Individual
Name
Jack Michael Costa, M.D.
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Dermatology
Credential
M.D.
Enumeration Date
Nov 17, 2006
Last Updated
Dec 30, 2010

Practice Location

Address
3650 JOSEPH SIEWICK DR
Address 2
SUITE 202
ZIP Code
22033-1710
Phone
(703) 391-2516

Specialties & Taxonomy Codes

Specialty
Dermatology

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