Provider Demographics
NPI:1871630350
Name:ROSENTHAL, SETH IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:IAN
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 1:5301 VIRGINIA WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7542
Mailing Address - Country:US
Mailing Address - Phone:615-221-4400
Mailing Address - Fax:615-695-4962
Practice Address - Street 1:1901 PHOENIX BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5062
Practice Address - Country:US
Practice Address - Phone:615-221-4400
Practice Address - Fax:615-695-4962
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88066207ZD0900X
MA234394207ZP0102X
GA83381207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71887OtherBLUECROSS BLUESHIELD
FLH90153Medicare UPIN
FL71887OtherBLUECROSS BLUESHIELD