Provider Demographics
NPI:1861468720
Name:SUCATO, GINA SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:SUZANNE
Last Name:SUCATO
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 1:13451 SE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1475
Mailing Address - Country:US
Mailing Address - Phone:425-562-1350
Mailing Address - Fax:
Practice Address - Street 1:13451 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1475
Practice Address - Country:US
Practice Address - Phone:425-562-1337
Practice Address - Fax:425-562-1331
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000362772080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001846189Medicaid
PA048778EB0Medicare ID - Type Unspecified