Healthcare Provider Details

I. General information

NPI: 1376545962
Provider Name (Legal Business Name): RUBEN DANIEL ACOSTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOCKWOOD DR STE 200
SILVER SPRING MD
20901-1562
US

IV. Provider business mailing address

106 ASHTON KNOLLS LN
ASHTON MD
20861-3647
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-2002
  • Fax:
Mailing address:
  • Phone: 860-416-9313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0095402
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: