| Doctor Name: | MRS. NICOLE KOCH |
| NPI Number: | 1043463680 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | C0003886 |
| Business Practice Address: | 10400 Connecticut Ave Ste 606 Kensington, MD - 208953910 |
| Business Phone Number: | 3019422212 |
| Business Fax Number: | 3019176501 |
| Mailing Address: | 2415 Musgrove Rd 3105, SILVER SPRING |
| State: | MD |
| Postal Code: | 209045202 |
| Phone Number: | 3019890193 |
| Fax Number: | 3018792325 |
| NPI Enumeration Date: | 10/28/2008 |
| NPI Last Update Date: | 12/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | C0003886 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |