Provider Demographics
NPI:1790926426
Name:SUSAN KINKEAD-ACREE, MD, PLLC
Entity Type:Organization
Organization Name:SUSAN KINKEAD-ACREE, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINKEAD-ACREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-992-6537
Mailing Address - Street 1:1485 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4501
Mailing Address - Country:US
Mailing Address - Phone:703-992-6537
Mailing Address - Fax:703-992-6539
Practice Address - Street 1:1320 OLD CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 420
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3956
Practice Address - Country:US
Practice Address - Phone:703-992-6537
Practice Address - Fax:703-992-6539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244394261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health