Healthcare Provider Details

I. General information

NPI: 1316218704
Provider Name (Legal Business Name): IAN M ROSENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NEW HAMPSHIRE AVE STE 3
PORTSMOUTH NH
03801-2864
US

IV. Provider business mailing address

111 NEW HAMPSHIRE AVE STE 2
PORTSMOUTH NH
03801-2864
US

V. Phone/Fax

Practice location:
  • Phone: 603-988-0951
  • Fax: 603-441-3722
Mailing address:
  • Phone: 802-909-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number23711
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number23711
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number35.128425
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: