Provider Demographics
NPI:1174668834
Name:ACOSTA, RAMON (RAMON ACOSTA, MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:RAMON ACOSTA, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-2404
Mailing Address - Country:US
Mailing Address - Phone:856-756-0010
Mailing Address - Fax:856-756-0011
Practice Address - Street 1:2 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-2404
Practice Address - Country:US
Practice Address - Phone:856-756-0010
Practice Address - Fax:856-756-0011
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO51166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223310412OtherTAX ID AMERICHOICE ID
NJ4009908Medicaid
NJ521135Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ223310412OtherTAX ID AMERICHOICE ID