Provider Demographics
NPI:1477598761
Name:JUBURI, RUDY HUZAM (MD)
Entity Type:Individual
Prefix:MR
First Name:RUDY
Middle Name:HUZAM
Last Name:JUBURI
Suffix:
Gender:M
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:P.O. BOX 1205
Mailing Address - Street 2:8030 MATTHEWS ROAD STE 105
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-3240
Mailing Address - Country:US
Mailing Address - Phone:301-375-8080
Mailing Address - Fax:301-375-6227
Practice Address - Street 1:8030 MATTHEWS RD
Practice Address - Street 2:STE 105
Practice Address - City:BRYANS ROAD
Practice Address - State:MD
Practice Address - Zip Code:20616
Practice Address - Country:US
Practice Address - Phone:301-375-8080
Practice Address - Fax:301-375-6227
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052362208D00000X
VA0101057764208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD179M199FMedicare ID - Type Unspecified
DCG02804F02Medicare PIN
MDG90828Medicare UPIN