Provider Demographics
NPI:1427406727
Name:VOLLSTAD, PEGGY (PA-C)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:VOLLSTAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:ANN
Other - Last Name:PEELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8205 BEARHURST DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3884
Mailing Address - Country:US
Mailing Address - Phone:571-383-4006
Mailing Address - Fax:
Practice Address - Street 1:3023 HAMAKER CT
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2207
Practice Address - Country:US
Practice Address - Phone:703-848-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004675363AS0400X
DCPA031065363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical