Provider Demographics
NPI:1841347879
Name:KOTTRA, JENNIFER A (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:KOTTRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LIBERTY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7949
Mailing Address - Country:US
Mailing Address - Phone:410-549-0900
Mailing Address - Fax:
Practice Address - Street 1:1010 LIBERTY RD STE 100
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-7949
Practice Address - Country:US
Practice Address - Phone:410-549-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0064686208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics