Provider Demographics
NPI:1154311694
Name:AQUINO, SUZANNE LEI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LEI
Last Name:AQUINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22100 BOTHELL EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8431
Mailing Address - Country:US
Mailing Address - Phone:855-687-7237
Mailing Address - Fax:
Practice Address - Street 1:97 LUMAHAI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-2104
Practice Address - Country:US
Practice Address - Phone:208-416-2932
Practice Address - Fax:855-673-9190
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012418982085R0202X
HIMD-143282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA155766OtherTUFTS HEALTH PLAN
MA3177971Medicaid
VA1154311694Medicaid
VAP0043258OtherMEDICARE RAILROAD
KY50017690OtherPASSPORT
MAJ18775OtherBCBS MA
VA21673300Medicaid
OH2833312Medicaid
KY3427944000OtherPASSPORT ADVANTAGE
PA102084165Medicaid
KY7100028710Medicaid
VAP00432958OtherMEDICARE RAILROAD
KY7100028710Medicaid
KY00533004Medicare PIN
KY3323297Medicare PIN
KY50017690OtherPASSPORT
PA102084165Medicaid
OHAQ7383181Medicare PIN
KY3427944000OtherPASSPORT ADVANTAGE
VAP00432958OtherMEDICARE RAILROAD
F97707Medicare UPIN
OH2833312Medicaid
VA21673300Medicaid
MA3177971Medicaid
ME417501Medicare PIN