Provider Demographics
NPI:1538131164
Name:WAKATSUKI, RACHEL (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WAKATSUKI
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 1:2993 SLEAFORD CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3214
Mailing Address - Country:US
Mailing Address - Phone:703-608-9407
Mailing Address - Fax:
Practice Address - Street 1:42010 VILLAGE CENTER PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:STONE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:20105-3032
Practice Address - Country:US
Practice Address - Phone:703-542-7921
Practice Address - Fax:703-542-7931
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I07763Medicare UPIN