1386658938 NPI number — CAROLE Z RUBIN MD

Table of content: CAROLE Z RUBIN MD (NPI 1386658938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386658938 NPI number — CAROLE Z RUBIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIN
Provider First Name:
CAROLE
Provider Middle Name:
Z
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386658938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3015 WILLIAMS DRIVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-4623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-641-9133
Provider Business Mailing Address Fax Number:
703-280-5098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3022 WILLIAMS DRIVE
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-698-8800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  D0047818 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 303661800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60234801 . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 80430027 . This is a "BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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