Provider Demographics
NPI:1184611444
Name:ROZA, ELI (MD)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:ROZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12931 OAK HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2914
Mailing Address - Country:US
Mailing Address - Phone:301-797-9600
Mailing Address - Fax:301-797-3854
Practice Address - Street 1:12931 OAK HILL AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2914
Practice Address - Country:US
Practice Address - Phone:301-797-9600
Practice Address - Fax:301-797-3854
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22313207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD440501300Medicaid
A72082Medicare UPIN
MD440501300Medicaid