Provider Demographics
NPI:1922034123
Name:WADUD, RUBINA (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBINA
Middle Name:
Last Name:WADUD
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 1:1301 48TH AVE N
Mailing Address - Street 2:STE B
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5427
Mailing Address - Country:US
Mailing Address - Phone:843-293-8360
Mailing Address - Fax:
Practice Address - Street 1:1301 48TH AVE N
Practice Address - Street 2:STE B
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-497-1441
Practice Address - Fax:843-497-3003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-23
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC21095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC210952Medicaid
H06631Medicare UPIN
SC7149Medicare ID - Type Unspecified