Healthcare Provider Details

I. General information

NPI: 1043365299
Provider Name (Legal Business Name): RESOURCE ANESTHESIOLOGY ASSOCIATES OF VA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2296 OPITZ BLVD STE 350
WOODBRIDGE VA
22191-3346
US

IV. Provider business mailing address

450 MAMARONECK AVE STE 201
HARRISON NY
10528-2436
US

V. Phone/Fax

Practice location:
  • Phone: 914-637-2075
  • Fax: 703-780-9518
Mailing address:
  • Phone: 914-637-2075
  • Fax: 914-819-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC E. KOCH
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 914-637-3511