Provider Demographics
NPI:1922053602
Name:RUBIN, BENJAMIN I (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:I
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 RENOIR CT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854
Mailing Address - Country:US
Mailing Address - Phone:301-309-1886
Mailing Address - Fax:301-762-2878
Practice Address - Street 1:7801 RENOIR CT
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854
Practice Address - Country:US
Practice Address - Phone:301-309-1886
Practice Address - Fax:301-762-2878
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD18973207W00000X
MDD0041632207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011152200Medicaid
MD770501800Medicaid
DC011152200Medicaid
MD527SMedicare PIN
MD770501800Medicaid