Provider Demographics
NPI:1184664831
Name:PICKARD, JULIA PATRICIA (MD)
Entity Type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:PATRICIA
Last Name:PICKARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:PATRICIA
Other - Last Name:PICKARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 TAVERN RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2864
Mailing Address - Country:US
Mailing Address - Phone:304-267-9355
Mailing Address - Fax:304-267-9358
Practice Address - Street 1:1000 TAVERN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2864
Practice Address - Country:US
Practice Address - Phone:304-267-9355
Practice Address - Fax:304-267-9358
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00232554OtherRAILROAD MEDICARE
WV9930421OtherMEDICARE GROUP NUMBER
WVC10269OtherRAILROAD GROUP
WVC10269OtherRAILROAD GROUP