Provider Demographics
NPI:1275500746
Name:SADEK, MONA (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:SADEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 COLONIAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4025
Mailing Address - Country:US
Mailing Address - Phone:540-774-6000
Mailing Address - Fax:540-774-5276
Practice Address - Street 1:4231 COLONIAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4025
Practice Address - Country:US
Practice Address - Phone:540-774-6000
Practice Address - Fax:540-774-5276
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101056592207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275500746Medicaid
VA010024820Medicaid
VAVVC036AMedicare PIN
VAG70564Medicare UPIN
VA1275500746Medicaid