Provider Demographics
NPI:1952317612
Name:KOCH, ALBERT FREDERICK III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:FREDERICK
Last Name:KOCH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:353 NEW SHACKLE ISLAND RD STE 300C
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2384
Mailing Address - Country:US
Mailing Address - Phone:615-824-0043
Mailing Address - Fax:615-822-1690
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD STE 300C
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2384
Practice Address - Country:US
Practice Address - Phone:615-824-0043
Practice Address - Fax:615-822-1690
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25789207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00411292OtherRAILROAD MEDICARE
OR213361Medicaid
ORI28436Medicare UPIN
OR00411292OtherRAILROAD MEDICARE
ORR135662Medicare PIN