Individual
DR. JOHN KEVIN KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 GRAND CENTRAL MALL, SUITE 2, VIENNA, WV 26105-4100
(304) 865-4350
(304) 865-4348
Mailing address
800 GRAND CENTRAL MALL, SUITE 2, VIENNA, WV 26105-4100
(304) 865-4350
(304) 865-4348
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
19553
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011154000
—
WV
01
—
201655
FEDERAL BLACK LUNG
—
05
—
2197448
—
OH
01
—
311599387-00
WORKERS COMP
OH
01
—
311599387003
MOUTAIN STATE BCBS
WV
01
—
9298571
MEDICARE PTAN
WV
Enumeration date
07/13/2005
Last updated
08/11/2011
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