Provider Demographics
NPI:1043691249
Name:GRADYS DE EPPLER, INDIRA FABIOLA (MD)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:FABIOLA
Last Name:GRADYS DE EPPLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INDIRA
Other - Middle Name:FABIOLA
Other - Last Name:GRADYS SOMARRIBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1160 VARNUM ST NE BLDG SUITE317
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-854-4900
Mailing Address - Fax:202-854-4910
Practice Address - Street 1:1160 VARNUM ST NE BLDG SUITE317
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-854-4900
Practice Address - Fax:202-854-4910
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMTL003108207R00000X
DCMD046414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine