Provider Demographics
NPI:1215424221
Name:SANTANA CEPERO, GRETCHEN (MD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:SANTANA CEPERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PROSPEROUS PL FL 3
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1882
Mailing Address - Country:US
Mailing Address - Phone:234-279-1609
Mailing Address - Fax:
Practice Address - Street 1:101 PROSPEROUS PL FL 3
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1882
Practice Address - Country:US
Practice Address - Phone:234-279-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.249932207R00000X
SC90217207RR0500X
390200000X
KY61072207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program