Provider Demographics
NPI:1194751586
Name:SOUMAI, MARYAM (MD)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:SOUMAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11728 FAIRFAX WOODS WAY
Mailing Address - Street 2:APT 1204
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8359
Mailing Address - Country:US
Mailing Address - Phone:202-361-5493
Mailing Address - Fax:707-802-6701
Practice Address - Street 1:4211 FAIRFAX CORNER EAST AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8622
Practice Address - Country:US
Practice Address - Phone:703-802-6700
Practice Address - Fax:703-802-6701
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101240765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine