Provider Demographics
NPI:1093730558
Name:ROSENTHAL, SAMUEL D (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:D
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 S EASTERN AVE #130
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-487-6880
Mailing Address - Fax:702-473-5455
Practice Address - Street 1:10120 S EASTERN AVE #130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-487-6880
Practice Address - Fax:702-473-5455
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13611207L00000X
NV17568207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI578908-01Medicaid
HIG98999Medicare UPIN
HI578908-01Medicaid