Healthcare Provider Details

I. General information

NPI: 1538125414
Provider Name (Legal Business Name): PAUL S KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 TOLL GATE RD
WARWICK RI
02886-2716
US

IV. Provider business mailing address

175 PARAMOUNT DR SUITE 203
RAYNHAM MA
02767-1065
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-4800
  • Fax: 401-738-0174
Mailing address:
  • Phone: 774-320-3040
  • Fax: 508-910-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD5359
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number038372
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: