Healthcare Provider Details

I. General information

NPI: 1215908199
Provider Name (Legal Business Name): RICHARD ADAM KOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

IV. Provider business mailing address

US MARINE FORCES COMMAND 1775 FORRESTAL DR BLDG 33
NORFOLK VA
23551-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4799
  • Fax: 910-450-4452
Mailing address:
  • Phone: 619-717-2526
  • Fax: 619-717-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2005-01664
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: