Provider Demographics
NPI:1861484453
Name:KOCH, DANIEL GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GREGORY
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 N ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7268
Mailing Address - Country:US
Mailing Address - Phone:704-732-8736
Mailing Address - Fax:704-732-8121
Practice Address - Street 1:1531 N ASPEN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-7268
Practice Address - Country:US
Practice Address - Phone:704-732-8736
Practice Address - Fax:704-732-8121
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138N8OtherBLUE CROSS BLUE SHIELD
NC89138N8Medicaid
2035954Medicare ID - Type Unspecified
NC89138N8Medicaid