Provider Demographics
NPI:1063435170
Name:ROSENTHAL, DONALD G (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
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 1:447 MERIDEN RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705
Mailing Address - Country:US
Mailing Address - Phone:203-574-5650
Mailing Address - Fax:203-574-7815
Practice Address - Street 1:447 MERIDEN RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705
Practice Address - Country:US
Practice Address - Phone:203-574-5650
Practice Address - Fax:203-574-7815
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010019644CT04OtherANTHEM BLUECROSS
CTD02629Medicare UPIN