MEDICARE: HOMAIRA BEHSUDI-WALI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101052538	VA

General Provider Information

NPI Number	:	1700942711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOMAIRA BEHSUDI-WALI MD

Provider Business Mailing Address
First Line	:	1608 SPRING HILL RD
Second Line	:	EMERGENCY USA
City	:	VIENNA
State	:	VA
Zip	:	22182
Country	:	US
Telephone Number	:	703-883-0900
Fax Number	:	703-883-0586

Provider Business Practice Location Address
First Line	:	1608 SPRING HILL RD
Second Line	:	EMERGENCY USA FAMILY MEDICAL CENTER
City	:	VIENNA
State	:	VA
Zip	:	22182
Country	:	US
Telephone Number	:	703-883-0900
Fax Number	:	703-883-0586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	11/27/2023

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