Individual
SERAPHINE A SOOSAIMANICKAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10701 ROSEMARY DR, KAISER PERMANENTE-MANASSAS, MANASSAS, VA 20109-7282
(703) 257-3000
(703) 257-3133
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE-MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101246093
VA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
25MA08030500
NJ
Other
Enumeration date
09/03/2006
Last updated
06/05/2021
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