Provider Demographics
NPI:1740225879
Name:ROSENTHAL, MICHAEL ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
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 1:100 YORK ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-787-3588
Mailing Address - Fax:203-777-3767
Practice Address - Street 1:100 YORK ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-787-3588
Practice Address - Fax:203-777-3767
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110015320OtherRAILROAD MEDICARE
010017374CT02OtherANTHEM INS.
2V6552OtherHEALTHNET
6270838OtherCIGNA
639328OtherCONNECTICARE
CT001173749Medicaid
1051478OtherAETNA HEALTHPLAN
6270838OtherCIGNA
1051478OtherAETNA HEALTHPLAN