| Mazen Madhoun Md Llc | |
|
6002 Winnbrook Ln Roanoke VA 24018-7907 | |
| (540) 397-5319 | |
| (540) 947-3142 |
| Full Name | Mazen Madhoun Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 6002 Winnbrook Ln, Roanoke, Virginia |
| Authorized Official Name and Position | Mazen Madhoun (OWNER) |
| Authorized Official Contact | 5403975319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mazen Madhoun Md Llc 6002 Winnbrook Ln Roanoke VA 24018-7907 Ph: (540) 397-5319 | Mazen Madhoun Md Llc 6002 Winnbrook Ln Roanoke VA 24018-7907 Ph: (540) 397-5319 |
| NPI Number | 1679904338 |
|---|---|
| Provider Enumeration Date | 12/06/2013 |
| Last Update Date | 03/06/2023 |
| Medicare PECOS PAC ID | 5092944181 |
|---|---|
| Medicare Enrollment ID | O20140213000649 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679904338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101247995 (Virginia) | Primary |
| Provider Name | Deetta J Ray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265539068 PECOS PAC ID: 9133139215 Enrollment ID: I20060503000773 |
| Provider Name | Mazen I Madhoun |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518127927 PECOS PAC ID: 5395930754 Enrollment ID: I20101110001315 |
| Provider Name | Ramona J Boyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871967257 PECOS PAC ID: 0749585198 Enrollment ID: I20160223000241 |
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