Provider Demographics
NPI:1861855926
Name:ACOSTA DIAZ, DANILO ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:DANILO
Middle Name:ALEJANDRO
Last Name:ACOSTA DIAZ
Suffix:
Gender:M
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:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:
Practice Address - Street 1:2800 S SHIRLINGTON RD STE 706
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3602
Practice Address - Country:US
Practice Address - Phone:571-777-2410
Practice Address - Fax:571-777-2411
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD047991207V00000X
VA0101275889207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology