Provider Demographics
NPI:1598772709
Name:PICKLOW, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:PICKLOW
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 1:1350 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9614
Mailing Address - Country:US
Mailing Address - Phone:740-439-0733
Mailing Address - Fax:740-439-8996
Practice Address - Street 1:1200 CLARK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9611
Practice Address - Country:US
Practice Address - Phone:740-439-8997
Practice Address - Fax:740-439-8996
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063543208800000X
PAMD057848L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1900532OtherUNITED HEALTH CARE
OH1900234OtherUNITED HEALTH CARE
PAPI817202OtherHIGHMARK
OH0959904Medicaid
OH53865OtherQUALCHOICE
GA340010224OtherPALMETTO GBA RAILROAD MED
OH1900410OtherUNITED HEALTH CARE
OH000000137273OtherANTHEM
OH1900532OtherUNITED HEALTH CARE
OHPI0752332Medicare PIN
OH000000137273OtherANTHEM
OHPI0752333Medicare PIN