Provider Demographics
NPI:1710987920
Name:RUBIN, ISADORE L (MD)
Entity Type:Individual
Prefix:
First Name:ISADORE
Middle Name:L
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:75 PIEDMONT AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2544
Mailing Address - Country:US
Mailing Address - Phone:404-756-1410
Mailing Address - Fax:404-756-1495
Practice Address - Street 1:35 JESSE HILL JR DR SE
Practice Address - Street 2:HUGHES SPALDING CHILDRENS HOSPITAL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3032
Practice Address - Country:US
Practice Address - Phone:404-616-4878
Practice Address - Fax:404-616-2416
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA039221208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000624412Medicaid
GA000624412Medicaid