Individual
DR. PAUL SANFORD PICKHOLTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD49699
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3810011422
MEDICAID
WV
01
—
P01203321
RR MEDICARE PTAN
WV
01
—
WV0682A
MEDICARE PTAN
WV
Enumeration date
08/21/2006
Last updated
04/21/2017
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