Healthcare Provider Details

I. General information

NPI: 1063956266
Provider Name (Legal Business Name): ANASTASIA KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 SAMUEL MORSE DR STE 100
COLUMBIA MD
21046-3444
US

IV. Provider business mailing address

7090 SAMUEL MORSE DR STE 100
COLUMBIA MD
21046-3444
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number209001077
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: