Provider Demographics
NPI:1992802474
Name:EDWARD S. ROSENTHAL, MD., LLC
Entity type:Organization
Organization Name:EDWARD S. ROSENTHAL, MD., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-581-4900
Mailing Address - Street 1:12000 MCCRACKEN RD
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2725000Medicaid
OH2725000Medicaid
OH9364791Medicare PIN