Provider Demographics
NPI:1982602355
Name:ACOSTA, PC
Entity Type:Organization
Organization Name:ACOSTA, PC
Other - Org Name:NOBLE HOUSE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:724-658-3020
Mailing Address - Street 1:3128 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1132
Mailing Address - Country:US
Mailing Address - Phone:724-658-3020
Mailing Address - Fax:724-658-6094
Practice Address - Street 1:3128 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1132
Practice Address - Country:US
Practice Address - Phone:724-658-3020
Practice Address - Fax:724-658-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB4860OtherRAILROAD
789831OtherBS
789831OtherBS