Provider Demographics
NPI:1083622369
Name:DACOSTA, NICOLAU N (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAU
Middle Name:N
Last Name:DACOSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NICOLAU
Other - Middle Name:
Other - Last Name:DACOSTA-NETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-270-7688
Mailing Address - Fax:717-270-3790
Practice Address - Street 1:252 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6111
Practice Address - Country:US
Practice Address - Phone:717-270-7688
Practice Address - Fax:717-270-3790
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053288L207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH08103Medicare UPIN