Provider Demographics
NPI:1619437860
Name:THANDALAM SOMASEKAR, MONIKA
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:THANDALAM SOMASEKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 MACE AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3315
Mailing Address - Country:US
Mailing Address - Phone:410-391-6996
Mailing Address - Fax:
Practice Address - Street 1:1124 MACE AVE
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3315
Practice Address - Country:US
Practice Address - Phone:410-391-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0095038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine