Provider Demographics
NPI:1588873939
Name:MALAISAMY, ANITHA (MD)
Entity type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:MALAISAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITHA
Other - Middle Name:
Other - Last Name:GURUSAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5308 SHOAL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-4226
Mailing Address - Country:US
Mailing Address - Phone:757-774-0122
Mailing Address - Fax:
Practice Address - Street 1:4012 RAINTREE RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3741
Practice Address - Country:US
Practice Address - Phone:757-488-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243834208000000X
MI4301085321208000000X
TXN7454208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101243834OtherVA MEDICAL LICENSE