Provider Demographics
NPI:1760126304
Name:KOCH, SANDRA NATALIE (DPM)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:NATALIE
Last Name:KOCH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:143 JOE KNOX AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9244
Mailing Address - Country:US
Mailing Address - Phone:704-662-3660
Mailing Address - Fax:704-662-3595
Practice Address - Street 1:10949 OLD ARDREY KELL RD STE 203
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4358
Practice Address - Country:US
Practice Address - Phone:704-803-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC860213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty