Provider Demographics
NPI:1447288253
Name:ACOSTA, NATASHA R (MD)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:R
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411054
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1054
Mailing Address - Country:US
Mailing Address - Phone:816-935-1704
Mailing Address - Fax:
Practice Address - Street 1:127 W 10TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1761
Practice Address - Country:US
Practice Address - Phone:816-404-0787
Practice Address - Fax:816-404-0701
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04337102085R0202X
MO20040069712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00704235OtherRR MEDICARE
MO205497407Medicaid
MO7119026OtherBCBS
MO337B00001Medicare PIN