NPIMap

Organization Active NPI

Mazen Madhoun MD LLC

  • Family Medicine Physician
  • Roanoke, VA
National Provider Identifier
1679904338
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101247995 Issued in VA
Legal business name
MAZEN MADHOUN MD LLC
Practice address
6002 Winnbrook LN
Roanoke, VA 24018-7907
Phone
(540) 397-5319
Fax
(540) 947-3142
NPI assigned
Dec 6, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mazen Madhoun, MDNPI 1518127927
Title
Owner
Phone
(540) 397-5319

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 0101247995 VA Primary

Addresses

Primary practice location

6002 Winnbrook LN
Roanoke, VA 24018-7907

Mailing address

6002 Winnbrook LN
Roanoke, VA 24018-7907
Phone (540) 397-5319

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140213000649 VA Part B Supplier - Clinic/Group Practice 5092944181 Receives reassigned benefits from 5 practitioners
Practice locations: Salem, VA; Rich Creek, VA; Blue Ridge, VA; Martinsville, VA; Blacksburg, VA; Blackstone, VA

National Provider Directory

National Provider Directory

Locations

3737 W Main St
Ste 101
Salem, VA 24153
Phone (540) 397-5319

3615 W Main St
Ste 101
Salem, VA 24153
Phone (540) 397-5319

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1679904338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6002 WINNBROOK LN",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240187907",
            "telephone_number": "540-397-5319",
            "fax_number": "540-947-3142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6002 WINNBROOK LN",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240187907",
            "telephone_number": "540-397-5319",
            "fax_number": "540-947-3142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAZEN MADHOUN MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-06",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "MADHOUN",
        "authorized_official_first_name": "MAZEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-397-5319",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101247995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.