Provider Demographics
NPI:1043602964
Name:PICKART, ANHTHU PHAM (PA-C)
Entity Type:Individual
Prefix:
First Name:ANHTHU
Middle Name:PHAM
Last Name:PICKART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NEW BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6999
Mailing Address - Country:US
Mailing Address - Phone:267-258-7200
Mailing Address - Fax:
Practice Address - Street 1:1238 CHEWS LANDING RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-2808
Practice Address - Country:US
Practice Address - Phone:856-497-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00360600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant