Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101247995 | VA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 0101247995 | VA |
NPI | 1518127927 |
---|---|
Provider Name | Mazen I Madhoun |
First Address | Roanoke, VA 24018-7907 |
Second Address | Salem, VA 24153-2073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 11/12/2020 |