Provider Demographics
NPI:1396823159
Name:ROSENTHAL, HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
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:PO BOX 22561
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-5161
Mailing Address - Country:US
Mailing Address - Phone:510-625-6266
Mailing Address - Fax:510-625-6266
Practice Address - Street 1:1800 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3466
Practice Address - Country:US
Practice Address - Phone:510-625-6266
Practice Address - Fax:510-625-6266
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG364692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G364690Medicaid
CA00G364690Medicaid
A46693Medicare UPIN