Provider Demographics
NPI:1831101278
Name:GOLDMAN, KATHRYN ROSENTHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ROSENTHAL
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:131 COVENTRY ST
Mailing Address - Street 2:BURGDORF CLINIC - 2ND FLOOR ADMINISTRATION
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1548
Mailing Address - Country:US
Mailing Address - Phone:860-714-3690
Mailing Address - Fax:860-714-8683
Practice Address - Street 1:131 COVENTRY ST
Practice Address - Street 2:BURGDORF CLINIC - 2ND FLOOR ADMINISTRATION
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1548
Practice Address - Country:US
Practice Address - Phone:860-714-3690
Practice Address - Fax:860-714-8683
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025723207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001257238Medicaid
CTE50414Medicare UPIN