Provider Demographics
NPI:1659775120
Name:KOCH, JANAE ROCHELLE
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:ROCHELLE
Last Name:KOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 WILLARD AVE
Mailing Address - Street 2:APT 626
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3611
Mailing Address - Country:US
Mailing Address - Phone:571-278-2222
Mailing Address - Fax:
Practice Address - Street 1:8484 GEORGIA AVE
Practice Address - Street 2:STE 100
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5604
Practice Address - Country:US
Practice Address - Phone:301-755-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005472363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical