Provider Demographics
NPI:1396746699
Name:RUBIN, S. BRUCE (MD)
Entity type:Individual
Prefix:
First Name:S.
Middle Name:BRUCE
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 1:12265 TOWNSEND RD
Mailing Address - Street 2:STE 500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1201
Mailing Address - Country:US
Mailing Address - Phone:215-856-1009
Mailing Address - Fax:215-856-1020
Practice Address - Street 1:9807 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3212
Practice Address - Country:US
Practice Address - Phone:215-676-2200
Practice Address - Fax:215-676-2408
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008263E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0052712000OtherKEYSTONE HEALTH PLAN EAST
PA36624OtherHEALTH PARTNERS
PA2187811OtherAETNA US HEALTHCARE
PA0006988500006Medicaid
PA0052712000OtherPERSONAL CHOICE/BSHIELD
PA016654OtherPA BLUE SHIELD
C27163Medicare UPIN
PA2187811OtherAETNA US HEALTHCARE