Provider Demographics
NPI:1821069451
Name:ROSENTHAL, STEPHEN HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HARRIS
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:34 ROSCOE ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494
Mailing Address - Country:US
Mailing Address - Phone:508-653-5047
Mailing Address - Fax:508-653-6045
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:#403
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:508-653-5047
Practice Address - Fax:508-653-5045
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA526152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3026361Medicaid
B95333Medicare UPIN
MA3026361Medicaid