Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 18872 | NH |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 18872 | NH |
NPI | 1437579323 |
---|---|
Provider Name | Jason T. Koch |
First Address | Nashua, NH 03061-3677 |
Second Address | Nashua, NH 03060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2014 |
Last Update Date | 05/06/2018 |