Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 19246 | MS |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD469053 | PA |
NPI | 1033156187 |
---|---|
Provider Name | Dr. Christian Albert Koch |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 24/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06936861 | (05) | MS |
I58717 | (02) | MS |
P01236774 | RAILROAD MEDICARE PTAN (01) | MS |