Provider Demographics
NPI:1649211228
Name:ROSENTHAL, SHELDON PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:PHILIP
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 1:807 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1240
Mailing Address - Country:US
Mailing Address - Phone:814-765-1484
Mailing Address - Fax:814-765-1575
Practice Address - Street 1:807 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1240
Practice Address - Country:US
Practice Address - Phone:814-765-1484
Practice Address - Fax:814-765-1575
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 038573-E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA128214OtherBLUE CROSS-BLUE SHIELD
PA1360541OtherUMW
PA213493OtherUPMC
PA10531OtherGEISINGER
PA0010877780001Medicaid
PA213493OtherUPMC
PAC31040Medicare UPIN