Provider Demographics
NPI:1184619579
Name:CEPPA, PEDRO RICARDO (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:RICARDO
Last Name:CEPPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 VARNUM ST NE
Mailing Address - Street 2:STE 104
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2151
Mailing Address - Country:US
Mailing Address - Phone:202-832-8320
Mailing Address - Fax:301-262-8291
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:STE 104
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-832-8320
Practice Address - Fax:301-262-8291
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCD6553208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023569700Medicaid
B94572Medicare UPIN
408995Medicare ID - Type Unspecified