Healthcare Provider Details

I. General information

NPI: 1255371738
Provider Name (Legal Business Name): MARILES VILORIA-GRAGEDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 RHODE ISLAND AVE NW STE 502
WASHINGTON DC
20036-3117
US

IV. Provider business mailing address

6910 RICHMOND HWY STE 110
ALEXANDRIA VA
22306-1850
US

V. Phone/Fax

Practice location:
  • Phone: 202-902-7324
  • Fax: 848-213-0063
Mailing address:
  • Phone: 703-660-8100
  • Fax: 703-768-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD600003129
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101265233
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0057571
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: