Provider Demographics
NPI:1013259845
Name:SEPEHRI, ELLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:
Last Name:SEPEHRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELNAZ
Other - Middle Name:
Other - Last Name:SEPEHRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:108 KENT SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5650
Mailing Address - Country:US
Mailing Address - Phone:240-888-3609
Mailing Address - Fax:
Practice Address - Street 1:3020 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6865
Practice Address - Country:US
Practice Address - Phone:202-469-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD046612208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics