Provider Demographics
NPI:1790740207
Name:RUBINO, MARY C (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:RUBINO
Suffix:
Gender:F
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA17907040207Medicaid
VA-002 / -003OtherTRICARE/CHAMPUS
NC08108OtherBC/BS
4138999OtherCIGNA
VA73368OtherSENTARA/OPTIMA
VAPAROtherVA HEALTH NETWORK
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL
VAPAROtherMULTIPLAN
VA2173441OtherMAMSI
NC5908108Medicaid
VAPAROtherCORVEL/CORCARE
VA309045OtherANTHEM
VAPAROtherVA PREMIER HEALTH
VAPAROtherAETNA
VAPAROtherVA HEALTH NETWORK
VAP00462696Medicare PIN
VA015350E30Medicare PIN