Provider Demographics
NPI:1619900529
Name:RUBIS, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:RUBIS
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:PO BOX 860
Mailing Address - Street 2:5220 CLAYTONSHIRE COURT
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-0860
Mailing Address - Country:US
Mailing Address - Phone:804-346-4246
Mailing Address - Fax:804-747-8470
Practice Address - Street 1:11525 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 103 & 104
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4763
Practice Address - Country:US
Practice Address - Phone:804-594-2550
Practice Address - Fax:804-594-3950
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033427174400000X
NC31376174400000X
GA040530174400000X
SC20090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7207891Medicaid
VA7207891Medicaid