Provider Demographics
NPI:1992854905
Name:KOCH, EDWARD G (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:G
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6707 OLD DOMINION DR
Mailing Address - Street 2:STE 300
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4503
Mailing Address - Country:US
Mailing Address - Phone:703-288-0794
Mailing Address - Fax:703-288-0796
Practice Address - Street 1:1635 N GEORGE MASON DR
Practice Address - Street 2:SUITE 185
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3601
Practice Address - Country:US
Practice Address - Phone:703-527-5155
Practice Address - Fax:703-525-3451
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101023302207V00000X
DCMD5187207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC057711K75Medicare PIN
C61686Medicare UPIN