Provider Demographics
NPI:1629069497
Name:KOCH, MARC E (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:E
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 MAMARONECK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-2436
Mailing Address - Country:US
Mailing Address - Phone:914-637-3511
Mailing Address - Fax:914-560-2227
Practice Address - Street 1:450 MAMARONECK AVE STE 201
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-2436
Practice Address - Country:US
Practice Address - Phone:914-637-3511
Practice Address - Fax:914-560-2227
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424232207LP2900X
PAMD424233208VP0000X, 208VP0000X
NY192817207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01654448Medicaid
VA1043365299Medicaid
PA1017403330001Medicaid
VA1548443153Medicaid
NY33A37YWXZ1Medicare PIN
VA1043365299Medicaid
VA00X657R02Medicare PIN
VA1548443153Medicaid
NY01654448Medicaid
NY33A37ZXWW1Medicare PIN
NY33A37YRXP1Medicare PIN
VAG02453R02Medicare PIN
NYRB3228Medicare PIN
F94123Medicare UPIN
NY38B271Medicare PIN