Healthcare Provider Details

I. General information

NPI: 1316884133
Provider Name (Legal Business Name): OTTO ROZA M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD STE 149
HAGERSTOWN MD
21742-6755
US

IV. Provider business mailing address

12931 OAK HILL AVE
HAGERSTOWN MD
21742-2914
US

V. Phone/Fax

Practice location:
  • Phone: 301-797-9600
  • Fax:
Mailing address:
  • Phone: 301-797-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENN DAWN ROHRER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 301-797-9600