Healthcare Provider Details

I. General information

NPI: 1740667617
Provider Name (Legal Business Name): KARI LYNN KOCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

IV. Provider business mailing address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1894
  • Fax:
Mailing address:
  • Phone: 207-626-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209253
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD22308
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number209253
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD22308
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: