Provider Demographics
NPI:1700942711
Name:BEHSUDI-WALI, HOMAIRA (MD)
Entity type:Individual
Prefix:
First Name:HOMAIRA
Middle Name:
Last Name:BEHSUDI-WALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HOMAIRA
Other - Middle Name:
Other - Last Name:BEHSUDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1608 SPRING HILL RD
Mailing Address - Street 2:EMERGENCY USA
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-883-0900
Mailing Address - Fax:703-883-0586
Practice Address - Street 1:1608 SPRING HILL RD
Practice Address - Street 2:EMERGENCY USA FAMILY MEDICAL CENTER
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-883-0900
Practice Address - Fax:703-883-0586
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93121Medicare UPIN