MEDICARE: DR. RITA C ACOSTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0008X	Hepatology Physician	ME 83497	FL

General Provider Information

NPI Number	:	1306013222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA C ACOSTA M.D.

Provider Business Mailing Address
First Line	:	1621 SPRING LAKE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-7100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 SPRING LAKE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-7100
Country	:	US
Telephone Number	:	407-864-5559
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	10/14/2009

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