Healthcare Provider Details

I. General information

NPI: 1760126304
Provider Name (Legal Business Name): SANDRA NATALIE KOCH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10949 OLD ARDREY KELL RD STE 203
CHARLOTTE NC
28277-4358
US

IV. Provider business mailing address

143 JOE KNOX AVE STE 100
MOORESVILLE NC
28117-9244
US

V. Phone/Fax

Practice location:
  • Phone: 704-803-8246
  • Fax:
Mailing address:
  • Phone: 704-662-3660
  • Fax: 704-662-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number860
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: