Provider Demographics
NPI:1952300279
Name:ROSENTHAL, STEVEN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
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 1:1365 ROCK QUARRY RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5029
Mailing Address - Country:US
Mailing Address - Phone:770-692-5830
Mailing Address - Fax:770-692-5835
Practice Address - Street 1:1365 ROCK QUARRY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5029
Practice Address - Country:US
Practice Address - Phone:770-692-5830
Practice Address - Fax:770-692-5835
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036445207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000525489DMedicaid
GA000525489EMedicaid
GA000525489DMedicaid
GA000525489EMedicaid