Provider Demographics
NPI:1932128782
Name:PICKETT, ROBERT ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:PICKETT
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 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-7260
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:222 22ND AVE N
Practice Address - Street 2:SUITE 400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-329-5144
Practice Address - Fax:615-284-4964
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35890207RC0000X, 207RC0001X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001227Medicaid
TNP01376969OtherRR MEDICARE
MS04406272Medicaid
TN6011910OtherBLUE CROSS-BLUE SHIELD
TNP00669735OtherRR MEDICARE
TN3001227Medicare PIN
MS04406272Medicaid
TN6011910OtherBLUE CROSS-BLUE SHIELD
TNG63081Medicare UPIN
TN103I064443Medicare PIN