Provider Demographics
NPI:1386704997
Name:MOLBERG, PETER JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:MOLBERG
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 1:7000 ANKARA PL
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20189-7000
Mailing Address - Country:US
Mailing Address - Phone:801-277-8365
Mailing Address - Fax:
Practice Address - Street 1:U S DEPT OF STATE MED # SA-1
Practice Address - Street 2:2401 E. STREET NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0001
Practice Address - Country:US
Practice Address - Phone:202-663-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine