Healthcare Provider Details

I. General information

NPI: 1871630350
Provider Name (Legal Business Name): SETH IAN ROSENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CRANBERRY HL STE 105
LEXINGTON MA
02421-7397
US

IV. Provider business mailing address

1 CRANBERRY HL STE 105
LEXINGTON MA
02421-7397
US

V. Phone/Fax

Practice location:
  • Phone: 800-325-7284
  • Fax: 205-579-9387
Mailing address:
  • Phone: 800-325-7284
  • Fax: 205-579-9387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME88066
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number234394
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number83381
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: