Healthcare Provider Details

I. General information

NPI: 1467466995
Provider Name (Legal Business Name): MARVELA GRATIA HERMANUS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N MAIN STREET EXT STE 2A2
WALLINGFORD CT
06492-2483
US

IV. Provider business mailing address

888 WORCESTER ST SUITE 130
WELLESLEY MA
02482-3744
US

V. Phone/Fax

Practice location:
  • Phone: 203-626-5581
  • Fax:
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM00314
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2209
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: