Provider Demographics
NPI:1619940988
Name:RUBERG, ELIZABETH ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:RUBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1136 THORN RUN RD
Mailing Address - Street 2:L
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4301
Mailing Address - Country:US
Mailing Address - Phone:412-262-1160
Mailing Address - Fax:412-262-1919
Practice Address - Street 1:1136 THORN RUN RD
Practice Address - Street 2:L
Practice Address - City:MOONTOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108
Practice Address - Country:US
Practice Address - Phone:412-262-1160
Practice Address - Fax:412-262-1919
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2015-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA0S003738L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1748900Medicaid
PA1748900Medicaid
B29794Medicare UPIN