Rafael Antonio Acosta, DDS
Individual provider Active NPI Endodontics · Clinton, MD
NPI 1902232614 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1902232614
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 15692 (MD)
- Practice address
- 7905 Malcolm Rd Ste 300
Clinton, MD 20735 - Phone
- (301) 868-5500
- NPI assigned
- Sep 25, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 29, 2015 through Dec 29, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15692 | MD | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alan J. Goodfriend, DMD, Glenn C. Schermer, DMD, Guido Costa, DMD,P.a. | Endodontics | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 15692 | MD | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
7905 Malcolm Rd Ste 300
Clinton, MD 20735
Mailing address
7905 Malcolm Rd Ste 300
Clinton, MD 20735-1708
Phone (301) 868-5500
Other practice location 1
605 Post Office Rd Ste 202
Waldorf, MD 20602-1913
Phone (301) 843-3290
Other practice location 2
6201 Greenbelt Rd Ste U11
Berwyn Heights, MD 20740-2347
Phone (301) 345-3800
Other practice location 3
22888 Three Notch Rd Ste 102
California, MD 20619-3114
Phone (301) 737-5507
Other practice location 4
995 Prince Frederick Blvd Ste 104
Prince Frederick, MD 20678-3199
Phone (443) 532-3123
Other providers in Clinton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.