Healthcare Provider Details

I. General information

NPI: 1003879594
Provider Name (Legal Business Name): THOMAS M ROSENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 WEST CARROLL STREET
SALISBURY MD
21801
US

IV. Provider business mailing address

322 WEST CARROLL STREET
SALISBURY MD
21801
US

V. Phone/Fax

Practice location:
  • Phone: 410-860-8446
  • Fax: 410-548-4119
Mailing address:
  • Phone: 410-860-8446
  • Fax: 410-548-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0043532
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0043532
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD0043532
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: