Active NPI
Jennifer A Kottra, D.O
- Pediatrics Physician
- Eldersburg, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- H0064686
- Practice address
- 1010 Liberty Rd Ste 100
Eldersburg, MD 21784-7949 - Phone
- (410) 549-0900
- NPI assigned
- Jan 4, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | H0064686 | MD | Primary |
Addresses
Primary practice location
1010 Liberty Rd Ste 100
Eldersburg, MD 21784-7949
Mailing address
1010 Liberty Rd Ste 100
Eldersburg, MD 21784-7949
Phone (410) 549-0900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD, DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H0064686 | MD | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group, LLC | Pediatrics | Current | Accepting new patients |
| Privia Medical Group, LLC | Current | Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Carroll Hospital Center, Inc. | Past | Accepting new patients |
Locations
133 Defense Hwy
Ste 112
Annapolis, MD 21401
Phone (410) 573-0140
9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800
11350 Pembrooke Sq
Ste 304
Waldorf, MD 20603
Phone (301) 856-2810
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1811715436
-
- General Acute Care Hospital
- Westminster, MD
- NPI 1912904210
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841347879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 LIBERTY RD STE 100",
"city": "ELDERSBURG",
"state": "MD",
"postal_code": "217847949",
"telephone_number": "410-549-0900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 LIBERTY RD STE 100",
"city": "ELDERSBURG",
"state": "MD",
"postal_code": "217847949",
"telephone_number": "410-549-0900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOTTRA",
"first_name": "JENNIFER",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.O",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "H0064686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eldersburg, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.