Provider Demographics
NPI:1124036751
Name:ROSENTHAL, ELDAD (MD)
Entity Type:Individual
Prefix:
First Name:ELDAD
Middle Name:
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 1:25 COMMUNICATIONS WAY
Mailing Address - Street 2:MACC-REVENUE CYCLE
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1866
Mailing Address - Country:US
Mailing Address - Phone:508-957-8664
Mailing Address - Fax:508-957-8677
Practice Address - Street 1:525 LONG POND DRIVE
Practice Address - Street 2:FONTAINE MEDICAL CENTER
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1227
Practice Address - Country:US
Practice Address - Phone:508-432-4100
Practice Address - Fax:508-432-8951
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA56303207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3019292Medicaid
B98010Medicare UPIN
MAA23460Medicare UPIN