Provider Demographics
NPI:1821428798
Name:RUBEO, KATHERINE CONROY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:CONROY
Last Name:RUBEO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:CONROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1307 FEDERAL ST
Mailing Address - Street 2:SUITE B110
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-359-4436
Mailing Address - Fax:412-359-6899
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:SUITE B110
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-359-4436
Practice Address - Fax:412-359-6899
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA-056452363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103208516Medicaid