Healthcare Provider Details

I. General information

NPI: 1649241795
Provider Name (Legal Business Name): TODD BRIAN KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 SHERIDAN DR
WILLIAMSVILLE NY
14221-4801
US

IV. Provider business mailing address

9665 ROCKY PT
CLARENCE NY
14031-1588
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-1220
  • Fax: 716-631-1222
Mailing address:
  • Phone: 716-759-7717
  • Fax: 716-631-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1375681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: