Provider Demographics
NPI:1922211309
Name:KOCHENDERFER, JOANN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:MARIE
Last Name:KOCHENDERFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:910-295-5481
Practice Address - Street 1:205 PAGE ROAD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8798
Practice Address - Country:US
Practice Address - Phone:910-295-5511
Practice Address - Fax:910-295-5481
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00293207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907208Medicaid
NCFH2967440OtherFIRSTCAROLINACARE #
SCN0029GOtherSC MEDICAID PROVIDER #
NC145JYOtherBCBS NC PROVIDER #
NC199378OtherMEDCOST PROVIDER #
NC2067340Medicare PIN
NCP00424658Medicare PIN