Provider Demographics
NPI:1265731798
Name:KOCH, ERICA (ND)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1363
Mailing Address - Country:US
Mailing Address - Phone:802-728-9600
Mailing Address - Fax:888-283-8349
Practice Address - Street 1:43 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1363
Practice Address - Country:US
Practice Address - Phone:802-728-9600
Practice Address - Fax:888-283-8349
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0071770175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT12214003OtherMVP HEALTH CARE