Healthcare Provider Details

I. General information

NPI: 1821614132
Provider Name (Legal Business Name): JAMES G KOCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HYGEIA DR STE 1016
NEWARK DE
19713-2049
US

IV. Provider business mailing address

PO BOX 473
HARVARD MA
01451-0473
US

V. Phone/Fax

Practice location:
  • Phone: 302-255-1350
  • Fax:
Mailing address:
  • Phone: 585-698-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS024855
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: