Provider Demographics
NPI:1609948231
Name:ROSENTHAL, ELLEN G (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:G
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9 COMMERCIAL BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6118
Mailing Address - Country:US
Mailing Address - Phone:415-798-3106
Mailing Address - Fax:415-798-3180
Practice Address - Street 1:3260 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4861
Practice Address - Country:US
Practice Address - Phone:415-473-7377
Practice Address - Fax:415-473-6855
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2016-02-02
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Provider Licenses
StateLicense IDTaxonomies
CAG82191207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G821910Medicaid
CA00G821910Medicaid
CAF84414Medicare UPIN