Provider Demographics
NPI:1841417433
Name:ROUBENOFF, RONENN (MD, MHS)
Entity Type:Individual
Prefix:DR
First Name:RONENN
Middle Name:
Last Name:ROUBENOFF
Suffix:
Gender:M
Credentials:MD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MASSACHUSETTS AVE
Mailing Address - Street 2:602-321A
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4229
Mailing Address - Country:US
Mailing Address - Phone:617-871-5044
Mailing Address - Fax:
Practice Address - Street 1:12 CAMBRIDGE CTR
Practice Address - Street 2:B6A-6
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1453
Practice Address - Country:US
Practice Address - Phone:617-679-6450
Practice Address - Fax:617-679-3518
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72474207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ12771Medicare UPIN