Provider Demographics
NPI:1578731717
Name:DUBERSTEIN, AARON JOEL (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JOEL
Last Name:DUBERSTEIN
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 1:2320 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-2710
Mailing Address - Country:US
Mailing Address - Phone:765-477-7436
Mailing Address - Fax:765-477-1245
Practice Address - Street 1:2320 CONCORD RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2710
Practice Address - Country:US
Practice Address - Phone:765-477-7436
Practice Address - Fax:765-477-1245
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066390A207Y00000X, 207Y00000X
TN45709207Y00000X
AL32678207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN210242990Medicaid