Provider Demographics
NPI:1568430817
Name:KHOUDEIR, YASSER (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:YASSER
Middle Name:
Last Name:KHOUDEIR
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 OPITZ BLVD STE G-209
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3311
Mailing Address - Country:US
Mailing Address - Phone:703-523-0611
Mailing Address - Fax:703-670-2089
Practice Address - Street 1:2010 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-1110
Practice Address - Fax:540-689-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255048207R00000X, 208M00000X
PAMD061649L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016634470003Medicaid
PAP00469836OtherRAIL ROAD MEDICARE
PAP00469836OtherRAIL ROAD MEDICARE
PAG57324Medicare UPIN
PA000491TA8Medicare PIN