Provider Demographics
NPI:1063482172
Name:BRUBAKER, JAY KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:KENNETH
Last Name:BRUBAKER
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 1:2110 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-3200
Mailing Address - Country:US
Mailing Address - Phone:717-544-3022
Mailing Address - Fax:717-544-3021
Practice Address - Street 1:2110 HARRISBURG PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604-3200
Practice Address - Country:US
Practice Address - Phone:717-544-3022
Practice Address - Fax:717-544-3021
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012919E207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006876040002Medicaid
PA127131OtherHIGHMARK BLUE SHIELD
PA01350102OtherCAPITAL BLUE CROSS
PAP002665OtherGATEWAY HEALTH PLAN
PA4662910OtherAETNA NON-HMO
PA000687604Medicaid
PA20011 S101OtherGEISINGER HEALTH PLAN
PA0006876040001Medicaid
PA0006876040004Medicaid
PA516348OtherAETNA HMO
PA0006876040002Medicaid
PA20011 S101OtherGEISINGER HEALTH PLAN
PA000687604Medicaid