Provider Demographics
NPI:1912479528
Name:WASHINGTON, SONGCERAE (PA-C)
Entity Type:Individual
Prefix:
First Name:SONGCERAE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33100 CLEVELAND CLINIC BLVD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1390
Mailing Address - Country:US
Mailing Address - Phone:440-695-4000
Mailing Address - Fax:
Practice Address - Street 1:33100 CLEVELAND CLINIC BLVD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1390
Practice Address - Country:US
Practice Address - Phone:440-695-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08891363A00000X
OH50.005550RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant