Healthcare Provider Details

I. General information

NPI: 1275510257
Provider Name (Legal Business Name): MILTON KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOCKWOOD DR
SILVER SPRING MD
20901-1556
US

IV. Provider business mailing address

10801 LOCKWOOD DR
SILVER SPRING MD
20901-1556
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-2002
  • Fax:
Mailing address:
  • Phone: 301-593-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD14609
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0014609
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: