Healthcare Provider Details

I. General information

NPI: 1609966514
Provider Name (Legal Business Name): ABRAHAM A COSTER DPM LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE SUITE 608
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

4660 KENMORE AVE SUITE 608
ALEXANDRIA VA
22304-1306
US

V. Phone/Fax

Practice location:
  • Phone: 703-379-0700
  • Fax: 703-578-4161
Mailing address:
  • Phone: 703-379-0700
  • Fax: 703-578-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103000719
License Number StateVA

VIII. Authorized Official

Name: DR. JEFFREY SAMUEL COSTER
Title or Position: PRESIDENT
Credential: DPM
Phone: 703-379-0700