Provider Demographics
NPI:1558397646
Name:KOCHEL, RANDY L (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:L
Last Name:KOCHEL
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 1:5275 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9427
Mailing Address - Country:US
Mailing Address - Phone:717-442-8111
Mailing Address - Fax:717-442-8981
Practice Address - Street 1:5275 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9427
Practice Address - Country:US
Practice Address - Phone:717-442-8111
Practice Address - Fax:717-442-8981
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035484E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0117653OtherHIGHMARK BLUE SHIELD
PA0038359000OtherINDEPENDENCE BLUE CROSS
PAP00467179OtherRAILROAD MEDICARE
PAB37053OtherHEALTHAMERICA
PA39792 S1Q2OtherGEISINGER
PA001043620Medicaid
PA50072505OtherCAPITAL BLUE CROSS
PA513732OtherAETNA
PAP004430OtherGATEWAY
PA39792 S1Q2OtherGEISINGER
PA117653Medicare ID - Type Unspecified