Provider Demographics
NPI:1902804347
Name:KOOCH, JASON EVERETT (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EVERETT
Last Name:KOOCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-807-0366
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013001208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
50044478OtherKEYSTONE HEALTH CENTRAL
6432850OtherCIGNA HEALTHCARE
2299715000OtherAMERIHEALTH
P00230776OtherRAILROAD MEDICARE
1622793OtherHIGHMARK BLUE SHIELD
2170526OtherMAMSI
2299715000OtherKEYSTONE HEALTH EAST
PA1011608520001Medicaid
2299715000OtherINDEPENDENCE BLUE CROSS
50044478OtherCAPITAL BLUE CROSS
90338OtherGEISINGER HEALTH PLAN
821131OtherFIRST PRIORITY HEALTH
7466584OtherAETNA PPO
2458473OtherUNITED HEALTHCARE
397414OtherHEALTH AMERICA/HEALTH ASS
P3356842OtherOXFORD HEALTH PLANS
PAI09193Medicare UPIN
2170526OtherMAMSI