MEDICARE: JANAE ROCHELLE KOCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	C0005472	MD

General Provider Information

NPI Number	:	1659775120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANAE ROCHELLE KOCH

Provider Business Mailing Address
First Line	:	4440 WILLARD AVE
Second Line	:	APT 626
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-3611
Country	:	US
Telephone Number	:	571-278-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	8484 GEORGIA AVE
Second Line	:	STE 100
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-5604
Country	:	US
Telephone Number	:	301-755-6655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	10/13/2014

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