Healthcare Provider Details

I. General information

NPI: 1790299733
Provider Name (Legal Business Name): ELITE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15001 SHADY GROVE RD STE 120
ROCKVILLE MD
20850-6354
US

IV. Provider business mailing address

PO BOX 10616
GAITHERSBURG MD
20898-0616
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-0070
  • Fax:
Mailing address:
  • Phone: 301-251-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAYESH DAYAL
Title or Position: PHYSICIAN
Credential: MD
Phone: 301-251-0070