Provider Demographics
NPI:1508873670
Name:RUBEL, JEFFREY R (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:RUBEL
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 1:30 TOZER RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5510
Mailing Address - Country:US
Mailing Address - Phone:978-712-1100
Mailing Address - Fax:978-712-1120
Practice Address - Street 1:30 TOZER RD
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5510
Practice Address - Country:US
Practice Address - Phone:978-712-1100
Practice Address - Fax:978-712-1120
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160298207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2006910Medicaid
MA2006910Medicaid
H09304Medicare UPIN