Provider Demographics
NPI:1528192440
Name:ROSENTHAL, CARL V (LAC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:V
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 CHURCHVILLE RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3483
Mailing Address - Country:US
Mailing Address - Phone:410-836-5500
Mailing Address - Fax:410-836-5500
Practice Address - Street 1:1208 CHURCHVILLE RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3483
Practice Address - Country:US
Practice Address - Phone:410-836-5500
Practice Address - Fax:410-836-5500
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00803171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist