Provider Demographics
NPI:1275532970
Name:KUBICA, RONALD P (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:P
Last Name:KUBICA
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 1:4901 LANG AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4495
Mailing Address - Country:US
Mailing Address - Phone:505-842-8171
Mailing Address - Fax:505-246-0684
Practice Address - Street 1:4901 LANG AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-842-8171
Practice Address - Fax:505-246-0684
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14350207RX0202X
VT042-0011750207RX0202X
NM84-208207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30908666Medicaid
VT1016393Medicaid
830007509OtherRAILROAD MEDICARE
7060250OtherAETNA
NM73887Medicaid
VT001135004Medicare PIN
830007509OtherRAILROAD MEDICARE
NH001135001Medicare PIN