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NPI Code Detail

MEDICARE: NICHOLAS BURKE KOCH

MEDICARE: NICHOLAS BURKE 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
1390200000XStudent in an Organized Health Care Education/Training Program303189NC

General Provider Information

NPI Number : 1891374260
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS BURKE KOCH
Provider Business Mailing Address
First Line : 1000 BLYTHE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5871
Country : US
Telephone Number : 704-446-9243
Fax Number : 704-446-9120
Provider Business Practice Location Address
First Line : 1000 BLYTHE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5871
Country : US
Telephone Number : 704-446-9243
Fax Number : 704-446-9120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2021
Last Update Date : 12/17/2025

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Directions to “ NICHOLAS BURKE KOCH ” Practice Location

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