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General NPI Number Information
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NPI Number | 1598772709
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Entity Type | Individual
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Provider Name | THOMAS M PICKLOW MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 1200 CLARK ST
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City | CAMBRIDGE
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State | OH
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Zip | 43725-9611
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Country | US
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Telephone | 740-439-8997
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Fax | 740-439-8996
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Provider Business Mailing Address
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Address Line | 1350 CLARK ST
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City | CAMBRIDGE
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State | OH
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Zip | 43725-9614
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Country | US
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Telephone | 740-439-0733
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Fax | 740-439-8996
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35063543
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD057848L
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License Number State | PA
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