Provider Demographics
NPI:1861494023
Name:ROSENTHAL, SCOTT ERIC (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ERIC
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DO
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 45747
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5747
Mailing Address - Country:US
Mailing Address - Phone:215-338-1811
Mailing Address - Fax:215-338-3606
Practice Address - Street 1:2201 RIDGEWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1196
Practice Address - Country:US
Practice Address - Phone:610-375-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008858L208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001724373Medicaid
G81301Medicare UPIN
PA020438ZZKZMedicare PIN