Individual
ANITHA MALAISAMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4012 RAINTREE RD, SUITE 200A, CHESAPEAKE, VA 23321-3741
(757) 488-2223
Mailing address
5308 SHOAL CREEK RD, SUFFOLK, VA 23435-4226
(757) 774-0122
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101243834
VA
208000000X
Pediatrics Physician
4301085321
MI
208000000X
Pediatrics Physician
N7454
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101243834
VA MEDICAL LICENSE
VA
Enumeration date
05/22/2007
Last updated
09/30/2011
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