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

NPI #1972808335 in Fairfax, Virginia

Provider Information

NPI Number: 1972808335
Entity Type: Organization
Organization Name: Jack M. Costa, M.d., P.c.
Primary Specialty: Specialist
Enumeration Date: Jan 17, 2011
Last Updated: Jan 17, 2011

Practice Location

Address: 3650 JOSEPH SIEWICK DR
Address 2: SUITE 202
City: Fairfax
State: Virginia
ZIP Code: 22033-1710
Phone: (703) 391-2516

Authorized Official

Name: DR. JACK M. COSTA, M.D.
Title: OWNER
Phone: (703) 391-2516

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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