Provider Demographics
NPI:1285633016
Name:RUBIN, RENE R (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:R
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 1:207 N BROAD ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:215-561-0809
Mailing Address - Fax:215-561-0828
Practice Address - Street 1:207 N BROAD ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1500
Practice Address - Country:US
Practice Address - Phone:215-561-0809
Practice Address - Fax:215-561-0828
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAM0031135E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01947477Medicaid
111889N06Medicare ID - Type Unspecified
028754Medicare ID - Type Unspecified
PA01947477Medicaid