Provider Demographics
NPI:1245282151
Name:OMIDVAR, BERNA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:BERNA
Middle Name:MARIA
Last Name:OMIDVAR
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5130 DUKE ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2924
Mailing Address - Country:US
Mailing Address - Phone:202-552-9673
Mailing Address - Fax:703-751-2071
Practice Address - Street 1:5130 DUKE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2924
Practice Address - Country:US
Practice Address - Phone:202-552-9673
Practice Address - Fax:703-751-2071
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-07-30
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Provider Licenses
StateLicense IDTaxonomies
VA0101236769208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010117534Medicaid