Provider Demographics
NPI:1891734463
Name:ROSENTHAL, SANFORD (MD)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:
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:PO BOX 102635
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2635
Mailing Address - Country:US
Mailing Address - Phone:912-354-4800
Mailing Address - Fax:912-629-5821
Practice Address - Street 1:4720 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6292
Practice Address - Country:US
Practice Address - Phone:912-354-4800
Practice Address - Fax:912-629-5821
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011051207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
582023987006OtherCHAMPUS
GA000023372CMedicaid
GA511G701032OtherMEDICARE GROUP
GA00023372BMedicaid
GA1891734463OtherMEDICARE RAILROAD
GA450081OtherBLUE CROSS BLUE SHIELD
SCGPA977OtherMEDICAID GRP. SAV
GA450081OtherBLUE CROSS BLUE SHIELD
GA180017220Medicare PIN
GA0412940001Medicare NSC
GA1891734463OtherMEDICARE RAILROAD
GA000023372CMedicaid
GA0412940004Medicare NSC
GA18BDCMLMedicare PIN
D41011Medicare UPIN
GA00023372BMedicaid
GA0412940002Medicare NSC