Healthcare Provider Details

I. General information

NPI: 1326087321
Provider Name (Legal Business Name): WILLIAM C KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TURNBURRY HILL RD
LEXINGTON MA
02421-4334
US

IV. Provider business mailing address

5 TURNBURRY HILL RD
LEXINGTON MA
02421-4334
US

V. Phone/Fax

Practice location:
  • Phone: 781-322-7560
  • Fax:
Mailing address:
  • Phone: 781-322-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number78339
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: