Provider Demographics
NPI:1073610135
Name:RUBIN, STEVEN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDWARD
Last Name:RUBIN
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 1:10 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2025
Mailing Address - Country:US
Mailing Address - Phone:781-631-0754
Mailing Address - Fax:
Practice Address - Street 1:10 SHELDON RD
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2025
Practice Address - Country:US
Practice Address - Phone:781-631-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37507207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB73748Medicare UPIN
MAD14258Medicare ID - Type UnspecifiedPROVIDER NUMBER