Provider Demographics
NPI:1336470947
Name:RUBINA A ZAMAN, MD LLC
Entity Type:Organization
Organization Name:RUBINA A ZAMAN, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-693-3005
Mailing Address - Street 1:913 WYOMING AVE REAR
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1328
Mailing Address - Country:US
Mailing Address - Phone:570-693-3005
Mailing Address - Fax:
Practice Address - Street 1:913 WYOMING AVE REAR
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1328
Practice Address - Country:US
Practice Address - Phone:570-693-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050336L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014420340004Medicaid
PA0014420340004Medicaid