Provider Demographics
NPI:1073615530
Name:SOOSAIMANICKAM, SERAPHINE A (MD)
Entity Type:Individual
Prefix:
First Name:SERAPHINE
Middle Name:A
Last Name:SOOSAIMANICKAM
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE-MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:10701 ROSEMARY DR
Practice Address - Street 2:KAISER PERMANENTE-MANASSAS
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-7282
Practice Address - Country:US
Practice Address - Phone:703-257-3000
Practice Address - Fax:703-257-3133
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08030500207RG0300X
VA0101246093207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine