Provider Demographics
NPI:1851561294
Name:BUSHEHRI, NIMA MARCUS (DO)
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:MARCUS
Last Name:BUSHEHRI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 SOUTHERN AVE SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4689
Mailing Address - Country:US
Mailing Address - Phone:202-563-2201
Mailing Address - Fax:202-563-2202
Practice Address - Street 1:5980 9TH STREET
Practice Address - Street 2:INTREPID SPIRIT CENTER
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:571-231-1210
Practice Address - Fax:571-231-8808
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO.000152208100000X
MDH0071194208100000X
VA0102202678208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine