Provider Demographics
NPI:1588689632
Name:ROSENTHAL, RICHARD (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44125 WOODRIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6839
Mailing Address - Country:US
Mailing Address - Phone:703-729-8222
Mailing Address - Fax:703-729-8221
Practice Address - Street 1:44125 WOODRIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6839
Practice Address - Country:US
Practice Address - Phone:703-729-8222
Practice Address - Fax:703-729-8221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045165207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA290010816OtherRAILROAD MEDICARE
VA5848776Medicaid
VA290000204Medicare PIN
VAE38355Medicare UPIN
VA5848776Medicaid