Provider Demographics
NPI:1952466187
Name:KOCH, MYRON HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:HARRIS
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24 PARK ROW
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12037-1210
Mailing Address - Country:US
Mailing Address - Phone:518-392-6932
Mailing Address - Fax:518-392-9091
Practice Address - Street 1:24 PARK ROW
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-1210
Practice Address - Country:US
Practice Address - Phone:518-392-6932
Practice Address - Fax:518-392-9091
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0954832084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry