Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 0101246093 | VA |
Y | 111NI0900X | Internist | 0101246093 | VA |
N | 207RG0300X | Geriatric Medicine | 25MA08030500 | NJ |
NPI | 1073615530 |
---|---|
Provider Name | Seraphine A Soosaimanickam |
First Address | Rockville, MD 20852-4908 |
Second Address | Manassas, VA 20109-7282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 05/06/2021 |