Healthcare Provider Details

I. General information

NPI: 1174694319
Provider Name (Legal Business Name): EDWARD SEPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 K STREET NW STE 401
WASHINGTON DC
20036
US

IV. Provider business mailing address

2141 K STREET NW STE 401
WASHINGTON DC
20036
US

V. Phone/Fax

Practice location:
  • Phone: 202-833-4543
  • Fax:
Mailing address:
  • Phone: 202-833-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD034779
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: