Provider Demographics
NPI:1013979806
Name:RAUSCH, KATHLEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:RAUSCH
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 1:11490 COMMERCE PARK DR # 525
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1557
Mailing Address - Country:US
Mailing Address - Phone:703-448-6933
Mailing Address - Fax:
Practice Address - Street 1:1800 TOWN CENTER DR STE 222
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3238
Practice Address - Country:US
Practice Address - Phone:703-834-6244
Practice Address - Fax:703-834-6288
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047985207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6211275Medicaid
VA231688OtherANTHEM
VA37730001OtherCAREFIRST DC
VA37730001OtherCAREFIRST DC