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

Jack Michael Costa, MD

Individual provider Dermatology Physician · NPI 1144393935

Jack Michael Costa, MD is a Dermatology in Fairfax, Virginia. Graduated from George Washington University School of Medicine in 1971, 55 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
55
Trained at
George Washington University School of Medicine
Licensed in
VA
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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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

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 0101028288 (VA)

Record details

NPI number1144393935
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedNovember 17, 2006
Last updated in NPPESDecember 30, 2010
Mailing address3650 Joseph Siewick Drive, Suite 202, Fairfax, VA 22033

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDERMATOLOGY
Medical schoolGEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Graduated 1971 (55 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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