Provider Demographics
NPI:1356505846
Name:ELENA GRANTCHAROVA GEPPERT, MD PA
Entity Type:Organization
Organization Name:ELENA GRANTCHAROVA GEPPERT, MD PA
Other - Org Name:HARBOUR PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:GRANTCHAROVA
Authorized Official - Last Name:GEPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-334-3223
Mailing Address - Street 1:3033 MARINA BAY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3984
Mailing Address - Country:US
Mailing Address - Phone:281-334-3223
Mailing Address - Fax:281-334-4930
Practice Address - Street 1:3033 MARINA BAY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3984
Practice Address - Country:US
Practice Address - Phone:281-334-3223
Practice Address - Fax:281-334-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0221208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty