MEDICARE: SUSAN KINKEAD-ACREE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	01011244394	VA

General Provider Information

NPI Number	:	1487802575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KINKEAD-ACREE MD

Provider Business Mailing Address
First Line	:	1485 CHAIN BRIDGE RD
Second Line	:	SUITE 204
City	:	MC LEAN
State	:	VA
Zip	:	22101-4501
Country	:	US
Telephone Number	:	703-992-6537
Fax Number	:	703-992-6539

Provider Business Practice Location Address
First Line	:	1485 CHAIN BRIDGE RD
Second Line	:	SUITE 204
City	:	MC LEAN
State	:	VA
Zip	:	22101-4501
Country	:	US
Telephone Number	:	703-992-6537
Fax Number	:	703-992-6539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	07/21/2015

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