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 1:4879 MAYDE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6618
Mailing Address - Country:US
Mailing Address - Phone:703-620-6221
Mailing Address - Fax:703-620-6628
Practice Address - Street 1:3930 PENDER DR STE 230
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0992
Practice Address - Country:US
Practice Address - Phone:703-620-6221
Practice Address - Fax:703-620-6628
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010300363Medicaid
019978A01Medicare PIN