Provider Demographics
NPI:1760897276
Name:GAJERA, KRUPA (OD)
Entity Type:Individual
Prefix:DR
First Name:KRUPA
Middle Name:
Last Name:GAJERA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 LARSON CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7297
Mailing Address - Country:US
Mailing Address - Phone:443-791-9123
Mailing Address - Fax:
Practice Address - Street 1:332 140 VILLAGE RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6196
Practice Address - Country:US
Practice Address - Phone:410-848-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 2414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist