Provider Demographics
NPI:1639468762
Name:KOCH, LISA KRISTINE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:KRISTINE
Last Name:KOCH
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3560 MERIDIAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1731
Mailing Address - Country:US
Mailing Address - Phone:360-734-2800
Mailing Address - Fax:360-734-3818
Practice Address - Street 1:3614 MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1748
Practice Address - Country:US
Practice Address - Phone:360-734-2800
Practice Address - Fax:360-734-3818
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60533531207ZP0101X
WAML60230507207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1639468762Medicaid
WA8940588Medicare PIN