Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack M. Costa, MD, PC

Organization Specialist · NPI 1972808335

Jack M. Costa, MD, PC is a Specialist 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
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

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