Provider Demographics
NPI:1114029253
Name:ROSENTHAL, EDWARD J (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:ROSENTHAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6770 MAYFIELD RD STE 226
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2299
Mailing Address - Country:US
Mailing Address - Phone:440-461-6430
Mailing Address - Fax:440-460-2819
Practice Address - Street 1:6770 MAYFIELD RD STE 226
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:404-616-4304
Practice Address - Fax:440-460-2819
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH130308208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32119700Medicaid
WIG02458Medicare UPIN
WI32119700Medicaid