Healthcare Provider Details

I. General information

NPI: 1487001376
Provider Name (Legal Business Name): JOHN MICHAEL PICARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD STE 2E99
NEWARK DE
19718-2200
US

IV. Provider business mailing address

1630 ELDRIDGE DR
WEST CHESTER PA
19380-6460
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-5982
  • Fax:
Mailing address:
  • Phone: 484-919-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC1-0024861
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberC1-0024861
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: