Provider Demographics
NPI:1265439442
Name:LUBIN, ALAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:LUBIN
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:PO BOX 24908
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-0908
Mailing Address - Country:US
Mailing Address - Phone:440-442-4260
Mailing Address - Fax:440-442-0249
Practice Address - Street 1:730 SOM CENTER RD
Practice Address - Street 2:SUITE # 305
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2350
Practice Address - Country:US
Practice Address - Phone:440-442-4260
Practice Address - Fax:440-442-0249
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3502667207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164012Medicaid
OH0361973Medicare PIN
OH0164012Medicaid