Provider Demographics
NPI:1346225083
Name:ROSENTHAL, MARC A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
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 1:20 WALL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4758
Mailing Address - Country:US
Mailing Address - Phone:781-221-2800
Mailing Address - Fax:781-221-2680
Practice Address - Street 1:20 WALL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4758
Practice Address - Country:US
Practice Address - Phone:781-221-2800
Practice Address - Fax:781-221-2680
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209935208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHV0049OtherHARVARD PILGRIM HEALTH
MAJ23714OtherBLUE CROSS
MA0023639OtherNEIGHBORHOOD HEALTH
MA3547350OtherAETNA
MAB501026OtherCIGNA
MA12-04575OtherUNITED HEALTHCARE
MA0140449Medicaid
MA209935OtherTUFTS
MAB501026OtherCIGNA
MA12-04575OtherUNITED HEALTHCARE