Provider Demographics
NPI:1396290474
Name:ROSENTHAL, TARAN (LAC)
Entity type:Individual
Prefix:
First Name:TARAN
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5720 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5332
Mailing Address - Country:US
Mailing Address - Phone:919-361-0104
Mailing Address - Fax:919-361-0105
Practice Address - Street 1:5720 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5332
Practice Address - Country:US
Practice Address - Phone:919-361-0104
Practice Address - Fax:919-361-0105
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC691171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist