Provider Demographics
NPI:1588921605
Name:MANIKAM, RAMASAMY (PHD)
Entity type:Individual
Prefix:DR
First Name:RAMASAMY
Middle Name:
Last Name:MANIKAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PROFESSIONAL WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2584
Mailing Address - Country:US
Mailing Address - Phone:540-248-1006
Mailing Address - Fax:540-248-1106
Practice Address - Street 1:25 PROFESSIONAL WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2584
Practice Address - Country:US
Practice Address - Phone:540-248-1006
Practice Address - Fax:540-248-1106
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03316103TC0700X, 103TB0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities