Healthcare Provider Details

I. General information

NPI: 1073604971
Provider Name (Legal Business Name): RICHARD R. ROSENTHAL, MD, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8318 ARLINGTON BLVD SUITE #308
FAIRFAX VA
22031-5218
US

IV. Provider business mailing address

8318 ARLINGTON BLVD SUITE #308
FAIRFAX VA
22031-5218
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-4440
  • Fax: 703-280-4650
Mailing address:
  • Phone: 703-573-4440
  • Fax: 703-280-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. RICHARD R. ROSENTHAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-573-4440