Healthcare Provider Details

I. General information

NPI: 1992169320
Provider Name (Legal Business Name): MISS GAYTRI GUPTA ELERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MONTGOMERY VILLAGE AVE STE 103
GAITHERSBURG MD
20879-3530
US

IV. Provider business mailing address

6 MONTGOMERY VILLAGE AVE STE 103
GAITHERSBURG MD
20879-3530
US

V. Phone/Fax

Practice location:
  • Phone: 301-840-2208
  • Fax:
Mailing address:
  • Phone: 301-840-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMT211446
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0088916
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: