Healthcare Provider Details

I. General information

NPI: 1861484453
Provider Name (Legal Business Name): DANIEL GREGORY KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 N ASPEN ST
LINCOLNTON NC
28092-7268
US

IV. Provider business mailing address

1531 N ASPEN ST
LINCOLNTON NC
28092-7268
US

V. Phone/Fax

Practice location:
  • Phone: 704-732-8736
  • Fax: 704-732-8121
Mailing address:
  • Phone: 704-732-8736
  • Fax: 704-732-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200401245
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: