Provider Demographics
NPI:1942260682
Name:KOCH, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:KOCH
Other - Last Name:MCFARREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1776 BRUSH DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-7464
Mailing Address - Country:US
Mailing Address - Phone:775-885-1453
Mailing Address - Fax:
Practice Address - Street 1:1200 MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3821
Practice Address - Country:US
Practice Address - Phone:775-883-3636
Practice Address - Fax:775-882-2382
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6019207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013033Medicaid
NVA53544Medicare UPIN
NV002013033Medicaid