Provider Demographics
NPI:1396895272
Name:MARBARGER, PETER D (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:MARBARGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:D
Other - Last Name:MARBARGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 200149
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-0149
Mailing Address - Country:US
Mailing Address - Phone:907-561-3211
Mailing Address - Fax:907-562-7547
Practice Address - Street 1:3841 PIPER ST
Practice Address - Street 2:SUITE T-100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4624
Practice Address - Country:US
Practice Address - Phone:907-561-3211
Practice Address - Fax:907-562-7547
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1750208600000X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAA1750OtherMEDICAL LICENSE
AK1010675Medicaid
161030Medicare PIN
AKK165517Medicare UPIN
AK1010675Medicaid