Provider Demographics
NPI:1639147366
Name:RUBIN, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 INFIRMARY WAY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9288
Mailing Address - Country:US
Mailing Address - Phone:413-577-5000
Mailing Address - Fax:413-577-5488
Practice Address - Street 1:150 INFIRMARY WAY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9288
Practice Address - Country:US
Practice Address - Phone:413-577-5000
Practice Address - Fax:413-577-5488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA710892OtherHARVARD PILGRIM
MA475061OtherCONNECTICARE
MAB10525901OtherCIGNA
MAJ23147OtherBCBSMA
MA24823OtherHEALTH NEW ENGLAND
MA1130367OtherAETNA
MA187692OtherHEALTHSOURCE
MA410874OtherTUFTS
B99232Medicare UPIN
MAB10525901OtherCIGNA