Nicole Koch
Individual provider Active NPI Medical Physician Assistant · Kensington, MD
NPI 1043463680 · NPPES record last updated Dec 9, 2015
Key facts
- NPI
- 1043463680
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- C0003886 (MD)
- Practice address
- 10400 Connecticut Ave
Ste 606
Kensington, MD 20895-3910 - Phone
- (301) 942-2212
- Fax
- (301) 917-6501
- NPI assigned
- Oct 28, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110317000774 | DC | Practitioner - Physician Assistant | 7517140247 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Potomac Physician Associates | Past |
Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Interoperability endpoints
- nicole.koch@mfmap.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | C0003886 | MD | Yes |
Addresses
Primary practice location
10400 Connecticut Ave
Ste 606
Kensington, MD 20895-3910
Mailing address
2415 Musgrove Rd 3105
Silver Spring, MD 20904-5202
Phone (301) 989-0193
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All providers in Kensington, MD · Medical Physician Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.