Basic Information
Provider Information
NPI: 1003155060
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSENTHAL
FirstName: CARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 37090
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212973090
CountryCode: US
TelephoneNumber: 7032959360
FaxNumber: 7032959369
Practice Location
Address1: 4320 SEMINARY RD
Address2:  
City: ALEXANDRIA
State: VA
PostalCode: 223041535
CountryCode: US
TelephoneNumber: 7035043789
FaxNumber: 7032959369
Other Information
ProviderEnumerationDate: 02/11/2013
LastUpdateDate: 02/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X0024170648VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000X0001230611VAN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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