Physician Compare National (NPI:1790733913)

HEALTHCARE PROVIDER: GUPTA ETWARU MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1790733913
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7416187562
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140311001218
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ETWARU
	Individual professional last name
Provider First Name	GUPTA
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ALBERT EINSTEIN COLLEGE OF MEDICINE OF YESHIVA UNIVERSITY
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1815 ARNOLD DR
	Group Practice or individual's line 1 address
City	MARTINEZ
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	945534219
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050276
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CONTRA COSTA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y