Healthcare Provider Details

I. General information

NPI: 1740336940
Provider Name (Legal Business Name): JOSHUA ZEV ROSENTHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 08/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9881 BROKEN LAND PKWY SUITE 105
COLUMBIA MD
21046-1172
US

IV. Provider business mailing address

9881 BROKEN LAND PKWY SUITE 105
COLUMBIA MD
21046-1172
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-4344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0060481
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0060481
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: