Provider Demographics
NPI:1538914148
Name:KOSCHORRECK, BRIAN L
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:KOSCHORRECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7649 FORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:RIO
Mailing Address - State:WV
Mailing Address - Zip Code:26755-6413
Mailing Address - Country:US
Mailing Address - Phone:304-496-9818
Mailing Address - Fax:
Practice Address - Street 1:7649 FORD HILL RD
Practice Address - Street 2:
Practice Address - City:RIO
Practice Address - State:WV
Practice Address - Zip Code:26755-6413
Practice Address - Country:US
Practice Address - Phone:304-496-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant