Healthcare Provider Details

I. General information

NPI: 1164608816
Provider Name (Legal Business Name): MARJAN LEONI KOCH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 211
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 502
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-963-3573
  • Fax: 856-338-9211
Mailing address:
  • Phone: 856-968-7433
  • Fax: 856-968-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA08317100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: