Provider Demographics
NPI:1124461439
Name:ROSENTHAL, MADELYN E (MD)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:E
Last Name:ROSENTHAL
Suffix:
Gender:F
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:PO BOX 93505
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0114
Mailing Address - Country:US
Mailing Address - Phone:940-627-1435
Mailing Address - Fax:940-627-1453
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 370
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2110
Practice Address - Country:US
Practice Address - Phone:817-778-0777
Practice Address - Fax:817-479-9082
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.136808207RP1001X
TXT0910207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBCBS OF TEXAS
TXPENDINGMedicaid