Organization
CLIFTON CENTREVILLE MEDICAL ASSOCIATES
Active
Other names
CCMA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MALAK K ISAAC MD (MEDICAL DOCTOR /SOLE OWNER)
(703) 825-1401
Entity
Organization
Contact information
Practice address
5895 TRINITY PKWY, SUITE 100, CENTREVILLE, VA 20120-1995
(703) 802-2004
(703) 802-2113
Mailing address
5895 TRINITY PKWY, SUITE 100, CENTREVILLE, VA 20120-1996
(703) 825-1401
(703) 802-2113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101237688
VA
207R00000X
Internal Medicine Physician
Primary
0101-049277
VA
2084N0400X
Neurology Physician
0101-049277
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006078508
—
VA
01
—
VV1662B
MEDICARE GBA
VA
Enumeration date
11/13/2006
Last updated
09/04/2024
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