Provider Demographics
NPI:1275697542
Name:ACOSTA, MARTHA IVON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:IVON
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HILDA ST STE 15
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2359
Mailing Address - Country:US
Mailing Address - Phone:407-574-4848
Mailing Address - Fax:407-518-1919
Practice Address - Street 1:201 HILDA ST STE 15
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2359
Practice Address - Country:US
Practice Address - Phone:407-574-4848
Practice Address - Fax:407-518-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13965208000000X
FLACN 253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59608Medicaid
FL77003Medicaid
FL61101POtherHUMANA
FL000491400Medicaid
FL51062Medicaid
FL5324601OtherCIGNA
FL68069OtherAMBETTER
FL87726AMedicaid