Provider Demographics
NPI:1649465683
Name:MARTIN E KOUTCHER MD PC
Entity type:Organization
Organization Name:MARTIN E KOUTCHER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC FACR
Authorized Official - Phone:215-336-0655
Mailing Address - Street 1:1328 W RITNER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3537
Mailing Address - Country:US
Mailing Address - Phone:215-336-0655
Mailing Address - Fax:215-271-2588
Practice Address - Street 1:1328 W RITNER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3537
Practice Address - Country:US
Practice Address - Phone:215-336-0655
Practice Address - Fax:215-271-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010174E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========Medicaid
PA=========OtherTIN
PA=========Medicare UPIN
PA=========OtherTIN
PA=========Medicaid