Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Jack M. Costa, MD, PC

Organization Specialist · NPI 1972808335

Jack M. Costa, MD, PC provides Specialist services in Fairfax, Virginia. Licensed in Virginia. Registered with an NPI since 2011.

Licensed in
VA
In the registry since
2011
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3650 Joseph Siewick Dr Ste 202
Fairfax, VA 22033-1710 Not confirmed with CMS for 15 years — call before visiting
Phone: (703) 391-2516
Fax: (703) 476-8244
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 0101028288 (VA)

Record details

NPI number1972808335
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jack Costa — Owner · (703) 391-2516
NPI enumeratedJanuary 17, 2011
Last updated in NPPESJanuary 17, 2011
Mailing address3650 Joseph Siewick Dr, Suite 202, Fairfax, VA 22033-1710

Other providers in Fairfax