Provider Demographics
NPI:1669103784
Name:BAGSBY-THORNTON, OVETTA A
Entity type:Individual
Prefix:MS
First Name:OVETTA
Middle Name:A
Last Name:BAGSBY-THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRADDOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15104-1637
Mailing Address - Country:US
Mailing Address - Phone:412-403-7184
Mailing Address - Fax:
Practice Address - Street 1:100 N BELLEFIELD AVE STE 6
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2600
Practice Address - Country:US
Practice Address - Phone:412-246-5619
Practice Address - Fax:412-346-5610
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital