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General NPI Number Information
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NPI Number | 1306252648
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Entity Type | Individual
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Provider Name | YVAN MAQUE ACOSTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 1100 FORREST AVE
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City | DOVER
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State | DE
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Zip | 19904-3309
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Country | US
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Telephone | 302-674-4627
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Fax |
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Provider Business Mailing Address
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Address Line | 22 VARITON DR
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City | WILMINGTON
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State | DE
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Zip | 19810-3135
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Country | US
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Telephone | 786-370-4171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | C1-0024364
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License Number State | DE
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