Provider Demographics
NPI:1669481578
Name:RUBINO, DANIEL THEODORE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:THEODORE
Last Name:RUBINO
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 1:176 E CONESTOGA RD
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333
Mailing Address - Country:US
Mailing Address - Phone:610-688-8580
Mailing Address - Fax:610-687-2246
Practice Address - Street 1:176 E CONESTOGA RD
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333
Practice Address - Country:US
Practice Address - Phone:610-688-8580
Practice Address - Fax:610-687-2246
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417839204C00000X
PAMD4178362081P2900X, 174400000X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No174400000XOther Service ProvidersSpecialist
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARU053563Medicare ID - Type UnspecifiedMCR PROVIDER #
PAH60300Medicare UPIN
PA053563Medicare PIN