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General NPI Number Information
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NPI Number | 1912078619
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Entity Type | Organization
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Legal Business Name | CLIFTON CENTREVILLE MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 5895 TRINITY PKWY SUITE 100
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City | CENTREVILLE
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State | VA
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Zip | 20120-1995
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Country | US
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Telephone | 703-802-2004
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Fax | 703-802-2113
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Provider Business Mailing Address
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Address Line | 5895 TRINITY PKWY SUITE 100
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City | CENTREVILLE
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State | VA
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Zip | 20120-1996
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Country | US
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Telephone | 703-825-1401
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Fax | 703-802-2113
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Authorized Official
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Title or Position | MEDICAL DOCTOR /SOLE OWNER
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Name | DR. MALAK K ISAAC
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Credential | MD
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Telephone | 703-825-1401
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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 | 0101237688
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0101-049277
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101-049277
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License Number State | VA
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