Provider Demographics
NPI:1336337989
Name:PICKHARDT, DONALD F III (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:F
Last Name:PICKHARDT
Suffix:III
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 1:515 ABBOTT RD STE 304
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1700
Mailing Address - Country:US
Mailing Address - Phone:716-995-8801
Mailing Address - Fax:716-995-8810
Practice Address - Street 1:515 ABBOTT RD STE 304
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1700
Practice Address - Country:US
Practice Address - Phone:716-995-8801
Practice Address - Fax:716-995-8810
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02649609Medicaid