Provider Demographics
NPI:1801904180
Name:ROSENTHAL, CHARLES M (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:ROSENTHAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:65 SOCKANOSSET CROSS RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5536
Mailing Address - Country:US
Mailing Address - Phone:401-354-4900
Mailing Address - Fax:401-354-8535
Practice Address - Street 1:115 CASS AVE
Practice Address - Street 2:HOSPITAL BASED LANDMARK MEDICAL CENTER
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895
Practice Address - Country:US
Practice Address - Phone:401-769-4100
Practice Address - Fax:401-767-1631
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2016-12-06
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Provider Licenses
StateLicense IDTaxonomies
RIMD71232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3142370OtherMASS WELFARE
245930OtherPILGRIM
31237OtherNEIGHBORHOOD HEALTH RI GR
400750OtherBLUECHIP RI
007123OtherTUFTS
3412OtherGROUP RI BLUESHIELD
RI7000915Medicaid
3142370OtherMASS WELFARE
RI007000641Medicare ID - Type Unspecified