MEDICARE: DR. JONATHAN H ROSENTHAL MD

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
1	207R00000X	Internal Medicine Physician	D42566	MD
2	207R00000X	Internal Medicine Physician	MD19273	DC
3	207RI0200X	Infectious Disease Physician	0101047053	VA

General Provider Information

NPI Number	:	1770659096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN H ROSENTHAL MD

Provider Business Mailing Address
First Line	:	2101 E JEFFERSON ST
Second Line	:	KAISER PERMANENTE MEDICARE ENROLLMENT
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 LOISDALE COURT
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-1885
Country	:	US
Telephone Number	:	703-922-1407
Fax Number	:	703-922-1111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	12/15/2011

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