Provider Demographics
NPI:1861470775
Name:PAVLIK, VICKIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:A
Last Name:PAVLIK
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 1:65951 OLD TWENTY ONE RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9012
Mailing Address - Country:US
Mailing Address - Phone:740-435-8500
Mailing Address - Fax:740-435-8513
Practice Address - Street 1:65951 OLD TWENTY ONE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9012
Practice Address - Country:US
Practice Address - Phone:740-435-8500
Practice Address - Fax:740-435-8513
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0518907Medicaid
OH0518907Medicaid
OHC02478Medicare UPIN