Provider Demographics
NPI:1811993660
Name:ACOSTA, MELVYN MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:MELVYN
Middle Name:MIGUEL
Last Name:ACOSTA
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:#576 CESAR GONZALEZ AVE.
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00919
Mailing Address - Country:US
Mailing Address - Phone:787-777-8202
Mailing Address - Fax:787-777-8204
Practice Address - Street 1:576 CESAR GONZALEZ AVE.
Practice Address - Street 2:SUITE 405
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-777-8202
Practice Address - Fax:787-777-8204
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR012450207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology