Healthcare Provider Details

I. General information

NPI: 1679893390
Provider Name (Legal Business Name): ELANA SIMON ROSENTHAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 N CHARLES ST
BALTIMORE MD
21218-5763
US

IV. Provider business mailing address

PO BOX 64442
BALTIMORE MD
21264-4442
US

V. Phone/Fax

Practice location:
  • Phone: 443-869-6867
  • Fax:
Mailing address:
  • Phone: 410-328-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD80074
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: