Individual
MR. GLENN R KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
961 MARCON BLVD, ALLENTOWN, PA 18109
(610) 266-0610
(610) 266-0293
Mailing address
961 MARCON BLVD, ALLENTOWN, PA 18109
(610) 266-0610
(610) 266-0292
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS005286L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016509210002
—
PA
01
—
01979901
INDIVIDUAL
—
01
—
02817200
CAPITAL GR NUMBER
—
01
—
0453403000
PIN
—
01
—
GL1454227
HIGHMARK
—
Enumeration date
02/05/2007
Last updated
07/08/2007
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