Provider Demographics
NPI:1982652954
Name:PICHLER, MARK HELMUT (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HELMUT
Last Name:PICHLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2919
Mailing Address - Country:US
Mailing Address - Phone:334-793-1964
Mailing Address - Fax:334-794-4131
Practice Address - Street 1:207 HAVEN DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2919
Practice Address - Country:US
Practice Address - Phone:334-793-1964
Practice Address - Fax:334-794-4131
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD08152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0009932818Medicaid
ALF99604Medicare UPIN