Provider Demographics
NPI:1083994271
Name:KOCHUBA, ANDREW LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LEONARD
Last Name:KOCHUBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 SAMUEL MORSE DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5317
Mailing Address - Country:US
Mailing Address - Phone:703-893-6168
Mailing Address - Fax:
Practice Address - Street 1:1825 SAMUEL MORSE DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5317
Practice Address - Country:US
Practice Address - Phone:703-893-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD210002211208200000X
MDD0093948208200000X
NC2018-02093208200000X
VA0101274320208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery