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NPI Code Detail

MEDICARE: JESSICA ROSENTHAL PA

MEDICARE: JESSICA ROSENTHAL PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant1367MA
2363A00000XPhysician AssistantPA00350RI
3363AM0700XMedical Physician Assistant1116CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11780672709OTHERGROUP NPI #

General Provider Information

NPI Number : 1215944590
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ROSENTHAL PA
Provider Business Mailing Address
First Line : PO BOX 9484
Second Line :
City : PROVIDENCE
State : RI
Zip : 02940-9484
Country : US
Telephone Number : 401-854-2508
Fax Number : 401-854-2519
Provider Business Practice Location Address
First Line : 593 EDDY ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02903-4923
Country : US
Telephone Number : 401-519-1604
Fax Number : 401-272-0538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 08/25/2014

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Directions to “ JESSICA ROSENTHAL PA” Practice Location

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