Provider Demographics
NPI:1457194201
Name:KAWACHI, SUZANNAH (PA-C)
Entity type:Individual
Prefix:
First Name:SUZANNAH
Middle Name:
Last Name:KAWACHI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 GREENSBORO DR STE 801
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4925
Mailing Address - Country:US
Mailing Address - Phone:703-942-9787
Mailing Address - Fax:
Practice Address - Street 1:8200 GREENSBORO DR STE 801
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4925
Practice Address - Country:US
Practice Address - Phone:703-942-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA110010099207N00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207N00000XAllopathic & Osteopathic PhysiciansDermatology