Healthcare Provider Details

I. General information

NPI: 1922211309
Provider Name (Legal Business Name): JOANN MARIE KOCHENDERFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PAGE ROAD
PINEHURST NC
28374-8798
US

IV. Provider business mailing address

205 PAGE ROAD
PINEHURST NC
28374-8798
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-5511
  • Fax: 910-295-5481
Mailing address:
  • Phone: 910-295-5511
  • Fax: 910-295-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2007-00293
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: