Provider Demographics
NPI:1851351423
Name:RUBIN, LAURENCE G (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:G
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7016 LEE PARK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3620
Mailing Address - Country:US
Mailing Address - Phone:804-746-5488
Mailing Address - Fax:804-730-1223
Practice Address - Street 1:7016 LEE PARK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3682
Practice Address - Country:US
Practice Address - Phone:804-746-5488
Practice Address - Fax:804-730-1223
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000849213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9332308Medicaid
VA480000600OtherRR PROVIDER #
VA9332308Medicaid