Provider Demographics
NPI:1326240557
Name:RUBENZIK, MARC KEVIN (MD PHD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:KEVIN
Last Name:RUBENZIK
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Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:393 E WALNUT STREET
Mailing Address - Street 2:PHR GROUP PROVIDER ENROLLMENT UNIT 3RD FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:877-608-0044
Mailing Address - Fax:877-514-0903
Practice Address - Street 1:233 S 10TH ST
Practice Address - Street 2:SUITE 450
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5541
Practice Address - Country:US
Practice Address - Phone:215-503-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2021-10-16
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Provider Licenses
StateLicense IDTaxonomies
CAA114347207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery