Provider Demographics
NPI:1861494023
Name:ROSENTHAL, SCOTT ERIC (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ERIC
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 AIDENN LAIR RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3231
Mailing Address - Country:US
Mailing Address - Phone:215-338-1811
Mailing Address - Fax:215-338-3606
Practice Address - Street 1:8019 FRANKFORD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2786
Practice Address - Country:US
Practice Address - Phone:215-338-1811
Practice Address - Fax:215-338-3606
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008858L208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001724373Medicaid
G81301Medicare UPIN
PA020438ZZKZMedicare PIN