Provider Demographics
NPI:1437255726
Name:PICKERT, STEVEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:PICKERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:THURMONT
Mailing Address - State:MD
Mailing Address - Zip Code:21788-1910
Mailing Address - Country:US
Mailing Address - Phone:301-271-4333
Mailing Address - Fax:301-271-7486
Practice Address - Street 1:100 S CENTER ST
Practice Address - Street 2:
Practice Address - City:THURMONT
Practice Address - State:MD
Practice Address - Zip Code:21788-1910
Practice Address - Country:US
Practice Address - Phone:301-271-4333
Practice Address - Fax:301-271-7486
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK586AD75Medicare PIN