Basic Information
| Provider Information | |||||||||
| NPI: | 1598772709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PICKLOW | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 CLARK ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437259614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404390733 | ||||||||
| FaxNumber: | 7404398996 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 CLARK ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437259611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404398997 | ||||||||
| FaxNumber: | 7404398996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 08/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35063543 | OH | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD057848L | PA | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 1900532 | 01 | OH | UNITED HEALTH CARE | OTHER | 1900234 | 01 | OH | UNITED HEALTH CARE | OTHER | PI817202 | 01 | PA | HIGHMARK | OTHER | 0959904 | 05 | OH | MEDICAID | 53865 | 01 | OH | QUALCHOICE | OTHER | 340010224 | 01 | GA | PALMETTO GBA RAILROAD MED | OTHER | 1900410 | 01 | OH | UNITED HEALTH CARE | OTHER | 000000137273 | 01 | OH | ANTHEM | OTHER |