Basic Information
| Provider Information | |||||||||
| NPI: | 1184944738 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOMAFAR | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4410 MEDICAL DR STE 410 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105756168 | ||||||||
| FaxNumber: | 2105107490 | ||||||||
| Practice Location | |||||||||
| Address1: | 12200 WARWICK BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236012344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575345100 | ||||||||
| FaxNumber: | 7575345395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2010 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | R6573 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 0101274513 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 840869 | 01 | TX | MEDICARE | OTHER | 8LL289 | 01 | TX | BCBS TX | OTHER | 401908501 | 05 | TX | MEDICAID |