Basic Information
Provider Information
NPI: 1861855926
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ACOSTA DIAZ
FirstName: DANILO
MiddleName: ALEJANDRO
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 37174
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212973174
CountryCode: US
TelephoneNumber: 5714235699
FaxNumber:  
Practice Location
Address1: 2800 S SHIRLINGTON RD STE 706
Address2:  
City: ARLINGTON
State: VA
PostalCode: 222063602
CountryCode: US
TelephoneNumber: 5717772410
FaxNumber: 5717772411
Other Information
ProviderEnumerationDate: 04/05/2016
LastUpdateDate: 10/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XMD047991DCN Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207V00000X0101275889VAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home