Provider Demographics
NPI:1235113317
Name:RUBIN, BRUCE KALMAN (MD MENGR MBA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:KALMAN
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD MENGR MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E MARSHALL ST
Mailing Address - Street 2:P.O. BOX 980646 VCU DEPT OF PEDIATRICS
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0646
Mailing Address - Country:US
Mailing Address - Phone:804-828-9602
Mailing Address - Fax:
Practice Address - Street 1:1001 E MARSHALL ST BOX 980646
Practice Address - Street 2:VCU DEPT OF PEDIATRICS
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0646
Practice Address - Country:US
Practice Address - Phone:804-828-9602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97015762080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
17762OtherPARTNERS
WV220407000Medicaid
370020986OtherRR MEDICARE
7556338OtherAETNA
VA6729738Medicaid
1093TOtherBCBS
SCQ0157CMedicaid
76111OtherMEDCOST
NC891093TMedicaid
76111OtherMEDCOST
WV220407000Medicaid