Provider Demographics
NPI:1326028846
Name:KOCHER, GARY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:KOCHER
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 1:1516 GREGG ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3530
Mailing Address - Country:US
Mailing Address - Phone:803-254-8143
Mailing Address - Fax:803-779-9782
Practice Address - Street 1:1516 GREGG ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3530
Practice Address - Country:US
Practice Address - Phone:803-254-8143
Practice Address - Fax:803-779-9782
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC570737477OtherTAX ID#
SC093437Medicaid
SCB91607Medicare UPIN
SCB916070281Medicare ID - Type Unspecified