Provider Demographics
NPI:1114949690
Name:RUBIN, TIGERLILY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIGERLILY LEE
Middle Name:
Last Name:RUBIN
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 1:2000 SPROUL RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008
Mailing Address - Country:US
Mailing Address - Phone:610-284-0200
Mailing Address - Fax:610-353-7932
Practice Address - Street 1:2000 SPROUL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008
Practice Address - Country:US
Practice Address - Phone:610-284-0200
Practice Address - Fax:610-353-7932
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-065239-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001954678Medicaid
PA001954678Medicaid