Provider Demographics
NPI:1578562062
Name:KOEN, JOSEPH LEE (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEE
Last Name:KOEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 MEDICAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4985
Mailing Address - Country:US
Mailing Address - Phone:757-625-4455
Mailing Address - Fax:757-625-1829
Practice Address - Street 1:300 MEDICAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-625-4455
Practice Address - Fax:757-625-1829
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101221499207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
20186OtherSENTARA HEALTH PLAN
271748OtherMDIPA/MAMSI
NC590581AOtherMEDICAID OF NC
VA140006635OtherRAILROAD MEDICARE
VA284493OtherANTHEM BCBS
5479722OtherANTHEM HEALTH PLAN
NC590581AOtherBCBS OF NC
VA006105611Medicaid
149158900OtherUS DEPT OF LABOR
VA284493OtherANTHEM BCBS
5479722OtherANTHEM HEALTH PLAN