Provider Demographics
NPI:1295798312
Name:RUBIN, ARTHUR BRUCE (DO)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:BRUCE
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1203 COLONIAL WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1921
Mailing Address - Country:US
Mailing Address - Phone:304-343-1863
Mailing Address - Fax:304-344-1755
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3302
Practice Address - Country:US
Practice Address - Phone:304-343-1863
Practice Address - Fax:304-344-1755
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0112455000Medicaid
WV0112455000Medicaid