Provider Demographics
NPI:1891791562
Name:ACOSTA, ROMEO JR (MD)
Entity Type:Individual
Prefix:
First Name:ROMEO
Middle Name:
Last Name:ACOSTA
Suffix:JR
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 1:6700 CROSSWINDS DR N
Mailing Address - Street 2:STE 200A
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5473
Mailing Address - Country:US
Mailing Address - Phone:727-344-4651
Mailing Address - Fax:727-347-6224
Practice Address - Street 1:6700 CROSSWINDS DR N
Practice Address - Street 2:STE 200A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5473
Practice Address - Country:US
Practice Address - Phone:727-344-4651
Practice Address - Fax:727-347-6224
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52037207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048759700Medicaid
D61484Medicare UPIN
07243Medicare ID - Type Unspecified