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General NPI Number Information
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NPI Number | 1104801729
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Entity Type | Individual
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Provider Name | TIMOTHY RICHARD KOCH M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 106 IRVING ST NW STE 301
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City | WASHINGTON
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State | DC
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Zip | 20010
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Country | US
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Telephone | 202-877-7788
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Fax | 877-680-8198
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Provider Business Mailing Address
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Address Line | 106 IRVING ST NW STE 301
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City | WASHINGTON
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State | DC
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Zip | 20010-2927
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Country | US
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Telephone | 202-877-7788
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Fax | 877-680-8198
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0101242696
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License Number State | VA
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