Provider Demographics
NPI:1871695593
Name:ROSENTHAL, LINDA ELLEN (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ELLEN
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 1:1300 BELLONA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5465
Mailing Address - Country:US
Mailing Address - Phone:410-583-0300
Mailing Address - Fax:410-583-0306
Practice Address - Street 1:1300 BELLONA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5466
Practice Address - Country:US
Practice Address - Phone:410-583-0300
Practice Address - Fax:410-583-0306
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033968207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410081600Medicaid
MDC06384Medicare UPIN
MD675L305DMedicare ID - Type Unspecified