Healthcare Provider Details

I. General information

NPI: 1992854905
Provider Name (Legal Business Name): EDWARD G KOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR SUITE 185
ARLINGTON VA
22205-3601
US

IV. Provider business mailing address

6707 OLD DOMINION DR STE 300
MC LEAN VA
22101-4503
US

V. Phone/Fax

Practice location:
  • Phone: 703-527-5155
  • Fax: 703-525-3451
Mailing address:
  • Phone: 703-288-0794
  • Fax: 703-288-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101023302
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD5187
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: