MEDICARE: DR. DONNA MARIE KOCH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MB069001	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083652853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA MARIE KOCH D.O.

Provider Business Mailing Address
First Line	:	297 PASSAIC STREET
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026
Country	:	US
Telephone Number	:	973-777-2293
Fax Number	:	973-777-9117

Provider Business Practice Location Address
First Line	:	297 PASSAIC STREET
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026
Country	:	US
Telephone Number	:	973-777-2293
Fax Number	:	973-777-9117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/12/2011

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