1598781833 NPI number — GAIL M KUBRIN M.D.

Table of content: GAIL M KUBRIN M.D. (NPI 1598781833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598781833 NPI number — GAIL M KUBRIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUBRIN
Provider First Name:
GAIL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1598781833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 S LANG AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15208-2745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-459-4446
Provider Business Mailing Address Fax Number:
724-459-4477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STATE ROUTE 1014
Provider Second Line Business Practice Location Address:
TORRANCE STATE HOSPITAL
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-459-4446
Provider Business Practice Location Address Fax Number:
724-459-4477
Provider Enumeration Date:
07/13/2006

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: 2084P0800X , with the licence number:  MD030433E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01711348 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 186878 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 564101 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 564101 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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