Individual provider Active NPI

Mark A. Rosenthal, M.D.

  • Pediatrics Physician
  • Gales Ferry, CT
National Provider Identifier
1144319690
Registry record updated Jan 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
037353 Issued in CT
Practice address
1527 Route 12
Box 608
Gales Ferry, CT 06335-1800
Phone
(860) 464-7248
Fax
(860) 464-0125
NPI assigned
Oct 12, 2006
Last updated
Jan 22, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 037353 CT Primary

Addresses

Primary practice location

1527 Route 12
Box 608
Gales Ferry, CT 06335-1800

Mailing address

1527 Route 12
PO Box 608
Gales Ferry, CT 06335-1800
Phone (860) 464-7248

Other identifiers 6

IdentifierTypeStateIssuer
010037353CT0OtherBLUE CROSS
01037353OtherCIGNA
OV5871OtherHEALTH NET
1204724OtherUNITED HEALTH CARE
001373539MedicaidCT
761223OtherCONNECTICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181226001768 CT Practitioner - Pediatric Medicine 3173868981 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
037353CTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. Pediatrics CurrentSince Nov 3, 2018 Accepting new patients
Gales Ferry Pediatric Group Past Accepting new patients

Locations

1527 Route 12
Gales Ferry, CT 06335
Phone (860) 464-7248

1527 Route 12
#608
Gales Ferry, CT 06335
Phone (860) 464-7248

365 Montauk Ave
Rm 2609
New London, CT 06320
Phone (860) 444-4739

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

Interoperability endpoints

  • Direct secure messaging: mrosenthal48329@direct.ynhh.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358812800000",
    "number": "1144319690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1527 ROUTE 12",
            "address_2": "PO BOX 608",
            "city": "GALES FERRY",
            "state": "CT",
            "postal_code": "063351800",
            "telephone_number": "860-464-7248",
            "fax_number": "860-464-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1527 ROUTE 12",
            "address_2": "BOX 608",
            "city": "GALES FERRY",
            "state": "CT",
            "postal_code": "063351800",
            "telephone_number": "860-464-7248",
            "fax_number": "860-464-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENTHAL",
        "first_name": "MARK",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2013-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "037353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "010037353CT0",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "01037353",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "OV5871",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1204724",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001373539",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "761223",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gales Ferry, CT

Sources for this page

Verify at the official NPI Registry.