Healthcare Provider Details

I. General information

NPI: 1790261790
Provider Name (Legal Business Name): RAQUEL KOCHIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LINDEN PONDS WAY
HINGHAM MA
02043
US

IV. Provider business mailing address

5525 RESEARCH PARK DR # 4
BALTIMORE MD
21228-4873
US

V. Phone/Fax

Practice location:
  • Phone: 781-534-7100
  • Fax: 781-534-7358
Mailing address:
  • Phone: 781-534-7100
  • Fax: 781-534-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2276813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: