Provider Demographics
NPI:1023064219
Name:RUBIN, ALEXANDER SASS (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SASS
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 1:6611 HUNTER TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2986
Mailing Address - Country:US
Mailing Address - Phone:301-788-0713
Mailing Address - Fax:
Practice Address - Street 1:6611 HUNTER TRAIL WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-2986
Practice Address - Country:US
Practice Address - Phone:301-698-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE42244207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
601285800OtherFECA
MD328171000Medicaid
MD839MK228Medicare ID - Type Unspecified
MD015650F85Medicare ID - Type Unspecified
601285800OtherFECA