1801904180 NPI number — CHARLES M ROSENTHAL MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801904180 NPI number — CHARLES M ROSENTHAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENTHAL
Provider First Name:
CHARLES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801904180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 SOCKANOSSET CROSS RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02920-5536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-354-4900
Provider Business Mailing Address Fax Number:
401-354-8535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 CASS AVE
Provider Second Line Business Practice Location Address:
HOSPITAL BASED LANDMARK MEDICAL CENTER
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-769-4100
Provider Business Practice Location Address Fax Number:
401-767-1631
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD7123 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3142370 . This is a "MASS WELFARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 245930 . This is a "PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31237 . This is a "NEIGHBORHOOD HEALTH RI GR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400750 . This is a "BLUECHIP RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007123 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3412 . This is a "GROUP RI BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7000915 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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