Provider Demographics
NPI:1861461758
Name:PICKLER, EVA CAROL (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:CAROL
Last Name:PICKLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21988 WILLISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:UPPERVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20184-3124
Mailing Address - Country:US
Mailing Address - Phone:423-534-5919
Mailing Address - Fax:
Practice Address - Street 1:26005 RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1892
Practice Address - Country:US
Practice Address - Phone:301-414-2300
Practice Address - Fax:301-414-0476
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36124207V00000X
VA0101840547207V00000X
MDD0080723207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4086863OtherBCBS OF TENNESSEE
TN3718898Medicaid
TN2547516OtherCIGNA
NC79065K7Medicaid
TNTN0105OtherJOHN DEERE INSURANCE CO
TN3872964Medicare PIN
TNTN0105OtherJOHN DEERE INSURANCE CO