Healthcare Provider Details

I. General information

NPI: 1245911973
Provider Name (Legal Business Name): PETER ANTHONY MOLLICA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 NEWTOWN RD
VIRGINIA BEACH VA
23462-5620
US

IV. Provider business mailing address

1605 CICERO CT
CHESAPEAKE VA
23322-7451
US

V. Phone/Fax

Practice location:
  • Phone: 757-499-7526
  • Fax:
Mailing address:
  • Phone: 757-749-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: