Provider Demographics
NPI:1750371936
Name:ROSENTHAL, DANIEL IRA (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:IRA
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 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8784
Mailing Address - Fax:617-726-5282
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8784
Practice Address - Fax:617-726-5282
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA389932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2087421Medicaid
MAM09759OtherBCBS MA
MA711971OtherTUFTS HEALTH PLAN
B87229Medicare UPIN
MAM09759OtherBCBS MA