Healthcare Provider Details

I. General information

NPI: 1083884753
Provider Name (Legal Business Name): WILLIAM HARRISON KOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2008
Last Update Date: 03/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MILBANK AVE
GREENWICH CT
06830-6616
US

IV. Provider business mailing address

151 MILBANK AVE
GREENWICH CT
06830-6616
US

V. Phone/Fax

Practice location:
  • Phone: 203-622-0337
  • Fax: 203-622-1726
Mailing address:
  • Phone: 203-622-0337
  • Fax: 203-622-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number025221
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: