Healthcare Provider Details

I. General information

NPI: 1104801729
Provider Name (Legal Business Name): TIMOTHY RICHARD KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW STE 301
WASHINGTON DC
20010
US

IV. Provider business mailing address

106 IRVING ST NW STE 301
WASHINGTON DC
20010-2927
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7788
  • Fax: 877-680-8198
Mailing address:
  • Phone: 202-877-7788
  • Fax: 877-680-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101242696
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: