Provider Demographics
NPI:1417343286
Name:BAKSH, RUBINA BATOOL (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBINA
Middle Name:BATOOL
Last Name:BAKSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUBINA
Other - Middle Name:BATOOL
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17 MEMORIAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4407
Mailing Address - Country:US
Mailing Address - Phone:864-283-0637
Mailing Address - Fax:864-283-0638
Practice Address - Street 1:17 MEMORIAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4407
Practice Address - Country:US
Practice Address - Phone:864-283-0637
Practice Address - Fax:864-283-0638
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCE608OtherMEDICARE
SC515393Medicaid