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General NPI Number Information
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NPI Number | 1679904338
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Entity Type | Organization
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Legal Business Name | MAZEN MADHOUN MD LLC
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 6002 WINNBROOK LN
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City | ROANOKE
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State | VA
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Zip | 24018-7907
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Country | US
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Telephone | 540-397-5319
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Fax | 540-947-3142
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Provider Business Mailing Address
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Address Line | 6002 WINNBROOK LN
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City | ROANOKE
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State | VA
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Zip | 24018-7907
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Country | US
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Telephone | 540-397-5319
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Fax | 540-947-3142
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAZEN MADHOUN
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Credential | MD
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Telephone | 540-397-5319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101247995
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License Number State | VA
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