Healthcare Provider Details

I. General information

NPI: 1952228249
Provider Name (Legal Business Name): GEHAN ELATTAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 MARTIN LUTHER KING JR BLVD STE 102
BALTIMORE MD
21201-1221
US

IV. Provider business mailing address

7402 CHADWELL CIR UNIT 101
WINDSOR MILL MD
21244-3996
US

V. Phone/Fax

Practice location:
  • Phone: 443-512-8337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberT19740
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: