Provider Demographics
NPI:1144400656
Name:THORNE, OLGA PETROVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:PETROVNA
Last Name:THORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:777 12TH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-1929
Mailing Address - Country:US
Mailing Address - Phone:916-550-5487
Mailing Address - Fax:
Practice Address - Street 1:7601 HOSPITAL DR STE 220
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5408
Practice Address - Country:US
Practice Address - Phone:916-689-3433
Practice Address - Fax:916-689-8943
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106908207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC264ZMedicare PIN