Provider Demographics
NPI:1912931270
Name:ROSENTHAL, A ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:ROY
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 1:10313 GEORGIA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5006
Mailing Address - Country:US
Mailing Address - Phone:301-681-3100
Mailing Address - Fax:301-681-3367
Practice Address - Street 1:10313 GEORGIA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-681-3100
Practice Address - Fax:301-681-3367
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD250041800Medicaid
MDDO9308Medicare UPIN