Provider Demographics
NPI:1710959549
Name:ROSENTHAL, JOHN GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGORY
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 1:5757 MONCLOVA RD STE 11
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1863
Mailing Address - Country:US
Mailing Address - Phone:419-873-6800
Mailing Address - Fax:419-873-6804
Practice Address - Street 1:5757 MONCLOVA RD STE 11
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1863
Practice Address - Country:US
Practice Address - Phone:419-873-6800
Practice Address - Fax:419-873-6804
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058361R207W00000X
OH35-058361207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH024591OtherONE HEALTH PLAN
OH0749300Medicaid
OH311550308019OtherCIGNA
OH4121872OtherAETNA
OH00642OtherPARAMOUNT
OH0800785OtherUNITED HEALTHCARE
OH000000121699OtherANTHEM
OH602258OtherFAMILY HEALTH PLAN
OHP62103OtherBLUE CARE
MI4110735Medicaid
OH1183130001OtherADMINASTAR
OHOC06130OtherNATIONWIDE HEALTH PLANS
OHOC06130OtherNATIONWIDE HEALTH PLANS
OH0749300Medicaid
OH4147951Medicare PIN
OH4147953Medicare PIN
OH024591OtherONE HEALTH PLAN
OH1183130001OtherADMINASTAR