Provider Demographics
NPI:1457330722
Name:BRUBAKER, PAUL E (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:BRUBAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:418 CLOVERLEAF RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9320
Mailing Address - Country:US
Mailing Address - Phone:717-653-1467
Mailing Address - Fax:717-653-1001
Practice Address - Street 1:418 CLOVERLEAF RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9320
Practice Address - Country:US
Practice Address - Phone:717-653-1467
Practice Address - Fax:717-653-1001
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015333E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA152951OtherHIGHMARK BLUE SHIELD
PA11635 S101OtherGEISINGER HEALTH PLAN
PA4658501OtherAETNA NON-HMO
PA516338OtherAETNA HMO
PA01652402OtherCAPITAL BLUE CROSS
PAB40017OtherHEALTH ASSURANCE
PA0006876500001Medicaid
PAP002666OtherGATEWAY HEALTH PLAN
PA0006876500001Medicaid
PA516338OtherAETNA HMO