Provider Demographics
NPI:1669840310
Name:MCCUTCHEON, LAURA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:MCCUTCHEON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:MCINERNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 E ST NW L209
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-663-1718
Mailing Address - Fax:
Practice Address - Street 1:2401 E ST NW L209
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-663-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2015-0072363AM0700X
DCPA200001599363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPA2015-0072OtherNM DEPARTMENT OF HEALTH MEDICAL LICENSE
DCPA200001599OtherDC DEPARTMENT OF HEALTH