Basic Information
| Provider Information | |||||||||
| NPI: | 1851363170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGIC | ||||||||
| FirstName: | ANTO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 LOTHROP ST | ||||||||
| Address2: | SUITE 9055 FORBES TOWER | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473087 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3471 5TH AVE | ||||||||
| Address2: | SUITE 810 LKB | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152133215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126924920 | ||||||||
| FaxNumber: | 4126924907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 08/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD426306 | PA | N | Other Service Providers | Specialist | 2084N0600X | MD426306 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | 2084N0400X | MD426306 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 207RS0012X | MD426306 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1739685 | 01 | PA | HIGHMARK MEDICARE | OTHER | 1012614800001 | 05 | PA | MEDICAID | P00263849 | 01 | PA | RAILROAD PALMETTO PA | OTHER |