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NPI Code Detail

MEDICARE: ALESSANDRO L ACOSTA-FAJARDO M.D.

MEDICARE: ALESSANDRO L ACOSTA-FAJARDO 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
1207Q00000XFamily Medicine Physician0045737FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437122165
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALESSANDRO L ACOSTA-FAJARDO M.D.
Provider Business Mailing Address
First Line : PO BOX 11406
Second Line :
City : BELFAST
State : ME
Zip : 04915-4005
Country : US
Telephone Number : 321-636-2621
Fax Number : 321-631-9436
Provider Business Practice Location Address
First Line : 1317 W POINT DR
Second Line :
City : COCOA
State : FL
Zip : 32922-6464
Country : US
Telephone Number : 321-636-2621
Fax Number : 321-631-9436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 04/15/2015

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Directions to “ ALESSANDRO L ACOSTA-FAJARDO M.D.” Practice Location

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