Provider Demographics
NPI:1760464150
Name:ROSENTHAL, RANDALL I (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:I
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 1:19 FRIENDSHIP ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2200
Mailing Address - Country:US
Mailing Address - Phone:401-848-5556
Mailing Address - Fax:401-848-5533
Practice Address - Street 1:19 FRIENDSHIP ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-848-5556
Practice Address - Fax:401-848-5533
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7453174400000X
RIMD07453207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRR00155Medicaid
RI007002325Medicare ID - Type Unspecified
RIRR00155Medicaid