Basic Information
| Provider Information | |||||||||
| NPI: | 1861461758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PICKLER | ||||||||
| FirstName: | EVA | ||||||||
| MiddleName: | CAROL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21988 WILLISVILLE RD | ||||||||
| Address2: | |||||||||
| City: | UPPERVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201843124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235345919 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26005 RIDGE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DAMASCUS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208721892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014142300 | ||||||||
| FaxNumber: | 3014140476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD36124 | TN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 0101840547 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D0080723 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4086863 | 01 | TN | BCBS OF TENNESSEE | OTHER | 3718898 | 05 | TN | MEDICAID | 2547516 | 01 | TN | CIGNA | OTHER | 79065K7 | 05 | NC | MEDICAID | TN0105 | 01 | TN | JOHN DEERE INSURANCE CO | OTHER |