Healthcare Provider Details

I. General information

NPI: 1710959549
Provider Name (Legal Business Name): JOHN GREGORY ROSENTHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 MONCLOVA RD STE 11
MAUMEE OH
43537-1863
US

IV. Provider business mailing address

5757 MONCLOVA RD STE 11
MAUMEE OH
43537-1863
US

V. Phone/Fax

Practice location:
  • Phone: 419-873-6800
  • Fax: 419-873-6804
Mailing address:
  • Phone: 419-873-6800
  • Fax: 419-873-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35058361R
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number35-058361
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: