Individual
KENNETH KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
200201425
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10058287
—
VA
01
—
13270
BCBS
NC
05
—
2006488000
—
WV
01
—
4300422
AETNA
—
01
—
801642
PARTNERS
NC
05
—
8913270
—
NC
01
—
C2528
MEDCOST
NC
05
—
Q01428
—
SC
Enumeration date
12/08/2005
Last updated
05/12/2008
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