Provider Demographics
NPI:1922130228
Name:ISAAC, MALAK K (MD)
Entity Type:Individual
Prefix:
First Name:MALAK
Middle Name:K
Last Name:ISAAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5895 TRINITY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1996
Mailing Address - Country:US
Mailing Address - Phone:703-825-1401
Mailing Address - Fax:
Practice Address - Street 1:5895 TRINITY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1996
Practice Address - Country:US
Practice Address - Phone:703-825-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD008020207Q00000X
VA0101240385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1922130228Medicaid
MD441960ZDDBMedicare PIN
VA013080P95Medicare PIN
MD442022YWV2Medicare PIN
VA1922130228Medicaid
014680C95Medicare PIN
MD441960YVZMedicare PIN