Healthcare Provider Details
I. General information
NPI: 1982602355
Provider Name (Legal Business Name): ACOSTA, PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/11/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3128 WILMINGTON RD
NEW CASTLE PA
16105-1132
US
IV. Provider business mailing address
3128 WILMINGTON RD
NEW CASTLE PA
16105-1132
US
V. Phone/Fax
- Phone: 724-658-3020
- Fax: 724-658-6094
- Phone: 724-658-3020
- Fax: 724-658-6094
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | PA |
VIII. Authorized Official
Name:
ELBERT
R
ACOSTA
II
Title or Position: OWNER/DIRECTOR
Credential: MD
Phone: 724-658-3020