Healthcare Provider Details

I. General information

NPI: 1174595631
Provider Name (Legal Business Name): KATHERINE KOCHENBACH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK STE 702
WHEELING WV
26003-6379
US

IV. Provider business mailing address

1 MEDICAL PARK STE 702
WHEELING WV
26003-6379
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-2945
  • Fax: 304-243-2945
Mailing address:
  • Phone: 304-243-2945
  • Fax: 304-243-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number35 091163
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: