Provider Demographics
NPI:1770456584
Name:MY WELLNESS WATCH PC
Entity type:Organization
Organization Name:MY WELLNESS WATCH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:ISSA
Authorized Official - Last Name:MADHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-397-5319
Mailing Address - Street 1:6002 WINNBROOK LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-7907
Mailing Address - Country:US
Mailing Address - Phone:540-397-5319
Mailing Address - Fax:540-900-0991
Practice Address - Street 1:6002 WINNBROOK LN
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-7907
Practice Address - Country:US
Practice Address - Phone:540-397-5319
Practice Address - Fax:540-900-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty