Provider Demographics
NPI:1801113386
Name:RUBIN, GERARD (DO)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E CHESTNUT ST STE 310
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5717
Mailing Address - Country:US
Mailing Address - Phone:207-623-2977
Mailing Address - Fax:207-621-1612
Practice Address - Street 1:6 E CHESTNUT ST STE 310
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5717
Practice Address - Country:US
Practice Address - Phone:207-623-2977
Practice Address - Fax:207-621-1612
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics