Provider Demographics
NPI:1467440255
Name:ROSENTHAL, NANCY SMUKLER (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SMUKLER
Last Name:ROSENTHAL
Suffix:
Gender:F
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-4357
Mailing Address - Fax:336-716-7595
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1009
Practice Address - Country:US
Practice Address - Phone:336-716-4357
Practice Address - Fax:336-716-7595
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32407207ZH0000X
NC2016-02046207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33951OtherWELLMARK BCBS
IA46326OtherWELLMARK BCBS
IA1174499Medicaid
IA0179499Medicaid
IA220025175Medicare PIN
IA46326OtherWELLMARK BCBS
IA0179499Medicaid
IAI9694Medicare PIN
IA46326Medicare PIN