Provider Demographics
NPI:1184944738
Name:HOMAFAR, HANNAH (MD)
Entity type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:
Last Name:HOMAFAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 MEDICAL DR STE 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3749
Mailing Address - Country:US
Mailing Address - Phone:210-575-6168
Mailing Address - Fax:210-510-7490
Practice Address - Street 1:12200 WARWICK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2344
Practice Address - Country:US
Practice Address - Phone:757-534-5100
Practice Address - Fax:757-534-5395
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR65732084N0400X
VA01012745132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX840869OtherMEDICARE
TX8LL289OtherBCBS TX
TX401908501Medicaid