Provider Demographics
NPI:1003805599
Name:RUBINSTEIN, JESSICA RAE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:RUBINSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8239
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:86 BAKER AVENUE EXT
Practice Address - Street 2:HVMA-CHMA DEPT OF PEDIATRICS
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2188
Practice Address - Country:US
Practice Address - Phone:978-287-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3048381Medicaid
J08994Medicare ID - Type Unspecified
MA3048381Medicaid