Healthcare Provider Details

I. General information

NPI: 1104447994
Provider Name (Legal Business Name): JOSHUA KYLE ROSENTHAL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 MEDICAL CENTER DR OFC
ROCKVILLE MD
20850-3357
US

IV. Provider business mailing address

9901 MEDICAL CENTER DR OFC
ROCKVILLE MD
20850-3357
US

V. Phone/Fax

Practice location:
  • Phone: 240-826-7072
  • Fax:
Mailing address:
  • Phone: 240-826-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC0007570
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: