Provider Demographics
NPI:1801854765
Name:HELENE M KOCH DO PC
Entity Type:Organization
Organization Name:HELENE M KOCH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-667-6363
Mailing Address - Street 1:25 BALA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:610-667-6363
Mailing Address - Fax:610-667-5155
Practice Address - Street 1:25 BALA AVENUE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:610-667-6363
Practice Address - Fax:610-667-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
088224Medicare ID - Type Unspecified