Provider Demographics
NPI:1386658938
Name:RUBIN, CAROLE Z (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:Z
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 1:3015 WILLIAMS DRIVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4623
Mailing Address - Country:US
Mailing Address - Phone:703-641-9133
Mailing Address - Fax:703-280-5098
Practice Address - Street 1:3022 WILLIAMS DRIVE
Practice Address - Street 2:STE 204
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4623
Practice Address - Country:US
Practice Address - Phone:703-698-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00478182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD303661800Medicaid
MD60234801OtherBLUE SHIELD
DC80430027OtherBLUE SHIELD
MD60234801OtherBLUE SHIELD
DC80430027OtherBLUE SHIELD