Healthcare Provider Details

I. General information

NPI: 1790949998
Provider Name (Legal Business Name): GREGORY THORKELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 01/31/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 FORWARD AVE STE 401
PITTSBURGH PA
15217-2255
US

IV. Provider business mailing address

5725 FORWARD AVE STE 401
PITTSBURGH PA
15217-2255
US

V. Phone/Fax

Practice location:
  • Phone: 412-214-0042
  • Fax: 412-385-2468
Mailing address:
  • Phone: 412-214-0042
  • Fax: 412-385-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMT193935
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME138552
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD443605
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: