Healthcare Provider Details

I. General information

NPI: 1841213212
Provider Name (Legal Business Name): JEROME DAVID KUTSCHERA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ST NW L209 WASHINGTON DC 20520-5712
WASHINGTON DC
20520-5712
US

IV. Provider business mailing address

6350 JERUSALEM PL
DULLES VA
20189-1360
US

V. Phone/Fax

Practice location:
  • Phone: 771-205-2277
  • Fax:
Mailing address:
  • Phone: 586-298-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008597
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: