MEDICARE: ALISA KUZNETSOVA PHYSICIAN ASSISTANT

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	363AM0700X	Medical Physician Assistant	C0008678	MD
2	363A00000X	Physician Assistant	PA200002399	DC

General Provider Information

NPI Number	:	1932826922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA KUZNETSOVA PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	4910 MASSACHUSETTS AVE NW STE 114
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4384
Country	:	US
Telephone Number	:	202-244-0812
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 MASSACHUSETTS AVE NW STE 114
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4384
Country	:	US
Telephone Number	:	202-244-0812
Fax Number	:

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

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	04/28/2026

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