Provider Demographics
NPI:1093731499
Name:MASOOD, KHAIRUNNISA (MD)
Entity type:Individual
Prefix:
First Name:KHAIRUNNISA
Middle Name:
Last Name:MASOOD
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 1:3650 JOSEPH SIEWICK DR STE 205B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1712
Mailing Address - Country:US
Mailing Address - Phone:703-620-6221
Mailing Address - Fax:703-620-6628
Practice Address - Street 1:3299 WOODBURN RD STE 350
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-7321
Practice Address - Country:US
Practice Address - Phone:703-573-0086
Practice Address - Fax:703-620-6628
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I64347Medicare UPIN
019978A01Medicare PIN