Provider Demographics
NPI:1063406197
Name:ROSENTHAL, EDWARD STEVEN (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:STEVEN
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 MCCRACKEN RD
Mailing Address - Street 2:#453
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2933
Mailing Address - Country:US
Mailing Address - Phone:216-581-4900
Mailing Address - Fax:216-581-7370
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:#453
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2933
Practice Address - Country:US
Practice Address - Phone:216-581-4900
Practice Address - Fax:216-581-7370
Is Sole Proprietor?:No
Enumeration Date:2005-09-05
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH357410002OtherCARESOURCE
OH000000189978OtherUNICARE
OH000000189978OtherANTHEM BLUE SHIELD
OH533832OtherADVANTRA FREEDOM
OH0700487Medicaid
OH4041169OtherAETNA
OHT53841OtherSUMMACARE HEALTH PLAN
OH357410002OtherCARESOURCE
OH0700487Medicaid
OH000000189978OtherANTHEM BLUE SHIELD