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General NPI Number Information
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NPI Number | 1194751586
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Entity Type | Individual
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Provider Name | MARYAM SOUMAI M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4211 FAIRFAX CORNER EAST AVE SUITE 230
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City | FAIRFAX
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State | VA
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Zip | 22030-8622
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Country | US
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Telephone | 703-802-6700
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Fax | 703-802-6701
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Provider Business Mailing Address
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Address Line | 11728 FAIRFAX WOODS WAY APT 1204
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City | FAIRFAX
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State | VA
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Zip | 22030-8359
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Country | US
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Telephone | 202-361-5493
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Fax | 707-802-6701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101240765
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License Number State | VA
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