Provider Demographics
NPI:1568423846
Name:RUBENSON, MARC S (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:S
Last Name:RUBENSON
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 1:125 CHASE WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-1717
Mailing Address - Country:US
Mailing Address - Phone:603-644-7936
Mailing Address - Fax:
Practice Address - Street 1:125 CHASE WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-1717
Practice Address - Country:US
Practice Address - Phone:603-644-7936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7332208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0106318Y0NH01OtherANTHEM
NHPMA336OtherHARVARD PILGRIM
NH30001527Medicaid
NH930OtherCIGNA NH
NH6318Medicare ID - Type Unspecified
NH30001527Medicaid