Healthcare Provider Details

I. General information

NPI: 1346225083
Provider Name (Legal Business Name): MARC A ROSENTHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/07/2021
Certification Date: 03/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WALL ST
BURLINGTON MA
01803-4758
US

IV. Provider business mailing address

20 WALL ST
BURLINGTON MA
01803-4758
US

V. Phone/Fax

Practice location:
  • Phone: 781-221-2800
  • Fax: 781-221-2680
Mailing address:
  • Phone: 781-221-2800
  • Fax: 781-221-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209935
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number209935
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: