Healthcare Provider Details

I. General information

NPI: 1760464150
Provider Name (Legal Business Name): RANDALL I ROSENTHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2005
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 FRIENDSHIP ST SUITE 220
NEWPORT RI
02840-2200
US

IV. Provider business mailing address

19 FRIENDSHIP ST SUITE 220
NEWPORT RI
02840-2200
US

V. Phone/Fax

Practice location:
  • Phone: 401-848-5556
  • Fax: 401-848-5533
Mailing address:
  • Phone: 401-848-5556
  • Fax: 401-848-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number7453
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD07453
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: