Provider Demographics
NPI:1003873126
Name:RUBENSTEIN, MITCHELL HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:HOWARD
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 LONGWOOD AVENUE
Mailing Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL DEPARTMENT OF DERMATOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-732-4918
Mailing Address - Fax:
Practice Address - Street 1:111 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6002
Practice Address - Country:US
Practice Address - Phone:857-307-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42710207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology