Provider Demographics
NPI:1942295852
Name:ROSENTHAL, RICHARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
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 1:8318 ARLINGTON BLVD
Mailing Address - Street 2:SUITE #308
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5218
Mailing Address - Country:US
Mailing Address - Phone:703-573-4440
Mailing Address - Fax:703-280-4650
Practice Address - Street 1:8318 ARLINGTON BLVD
Practice Address - Street 2:SUITE #308
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5218
Practice Address - Country:US
Practice Address - Phone:703-573-4440
Practice Address - Fax:703-280-4650
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2007-12-05
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
VA0101024127207KA0200X
MDD0013367207KA0200X
DCMD034748207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA408579R25Medicare PIN
VAC48942Medicare UPIN