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1144393935
JACK MICHAEL COSTA
FAIRFAX, VA
NPI
1144393935
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
207N00000X Dermatology
(Licence: VA 0101028288)
Enumeration Date
2006-11-17
Last Update Date
2010-12-30
Business Address
JACK MICHAEL COSTA M.D.
3650 JOSEPH SIEWICK DR SUITE 202
FAIRFAX, VA 22033-1710
Phone number: 703-391-2516
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Mailing Address
JACK MICHAEL COSTA M.D.
3650 JOSEPH SIEWICK DRIVE SUITE 202
FAIRFAX, VA 22033
Phone number: 703-391-2516
Copy
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