Provider Demographics
NPI:1992169320
Name:GUPTA ELERA, GAYTRI
Entity type:Individual
Prefix:MISS
First Name:GAYTRI
Middle Name:
Last Name:GUPTA ELERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3530
Mailing Address - Country:US
Mailing Address - Phone:301-840-2208
Mailing Address - Fax:
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3530
Practice Address - Country:US
Practice Address - Phone:301-840-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211446207W00000X
MDD0088916207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology