Healthcare Provider Details

I. General information

NPI: 1316939754
Provider Name (Legal Business Name): BARBARA LILLIAN ROSENTHAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 09/23/2021
Certification Date: 09/07/2021
Deactivation Date: 03/27/2006
Reactivation Date: 04/11/2006

III. Provider practice location address

RAILROAD ST
JOHNSON VT
05656
US

IV. Provider business mailing address

132 CANDLEWOOD DR
WILLIAMSTOWN MA
01267-2972
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-0000
  • Fax: 802-332-3819
Mailing address:
  • Phone: 802-447-0000
  • Fax: 802-442-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number192155-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number216297
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number042-000-8620
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420008620
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: