Provider Demographics
NPI:1851366264
Name:MOLLENHAUER, MARK (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:MOLLENHAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5415 W CEDAR LN
Mailing Address - Street 2:201B
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1515
Mailing Address - Country:US
Mailing Address - Phone:301-897-8779
Mailing Address - Fax:301-897-9149
Practice Address - Street 1:5415 W CEDAR LN
Practice Address - Street 2:201B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1515
Practice Address - Country:US
Practice Address - Phone:301-897-8779
Practice Address - Fax:301-897-9149
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD428462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF89221Medicare UPIN
491035Medicare ID - Type Unspecified