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General NPI Number Information
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NPI Number | 1760860936
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Entity Type | Organization
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Legal Business Name | MENTAL WELLNESS GROUP PLLC
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 09/23/2018
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Provider Practice Location Address
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Address Line | 3959 ELECTRIC RD STE 280
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City | ROANOKE
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State | VA
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Zip | 24018-4572
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Country | US
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Telephone | 540-427-7944
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Fax | 540-427-7945
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Provider Business Mailing Address
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Address Line | PO BOX 20867
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City | ROANOKE
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State | VA
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Zip | 24018-0526
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Country | US
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Telephone | 540-427-7944
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Fax | 540-427-7945
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Authorized Official
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Title or Position | OWNER
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Name | DR. MALAK ISKANDAR
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Credential | D.O.
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Telephone | 540-427-7944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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