Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JACK MICHAEL COSTA, M.D.
Active Sole ProprietorJACK MICHAEL COSTA, M.D. is a Dermatology healthcare provider located in FAIRFAX, Virginia. NPI 1144393935 is currently active in the NPPES registry. Verify at CMS.
Dermatology · FAIRFAX, VA
Registration Details
- NPI Number
- 1144393935
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Nov 17, 2006 (19.701857031383 yrs)
- Last Updated
- Dec 30, 2010
- License
-
0101028288 (VA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
3650 JOSEPH SIEWICK DRSUITE 202FAIRFAX, VA, 220331710Browse VA providers · Browse ZIP 22033
- Phone
- 7033912516
- Fax
- 7034768244
- Primary Specialty
-
Dermatology
207N00000X
Other Dermatology Providers in FAIRFAX, VA
| Name | Credential | NPI |
|---|---|---|
| HARRY WILMER WYRE JR. | M.D. | 1821096090 |
| DR. SURAJ S VENNA | MD | 1366433302 |
| DR. KATHY DIEP NGOC TIEU | M.D. | 1811973951 |
| DWANA RASHAD SHABAZZ | M.D. | 1548296817 |
| ALEXANDRA KAZAKIS | MD | 1386736288 |
| DR. ALAN ELLIS ROLFE | M.D. | 1295899953 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.