Provider Demographics
NPI:1982771747
Name:RUBRIGHT, HERBERT CHARLES JR (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:CHARLES
Last Name:RUBRIGHT
Suffix:JR
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 1:142 JAMES STREET
Mailing Address - Street 2:
Mailing Address - City:KASKA
Mailing Address - State:PA
Mailing Address - Zip Code:17959-1253
Mailing Address - Country:US
Mailing Address - Phone:570-277-0329
Mailing Address - Fax:
Practice Address - Street 1:401 UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-2212
Practice Address - Country:US
Practice Address - Phone:570-385-0331
Practice Address - Fax:570-385-1007
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022606E207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159845OtherHIGHMARK BLUE SHIELD
PA159845OtherFEDERAL BLUE SHIELD
PA01665101OtherCAPITAL BLUE CROSS PROVID
PA0010656720007Medicaid
PA02616500OtherCAPITAL BLUE CROSS GROUP
PA0010656720007Medicaid
PA159845OtherHIGHMARK BLUE SHIELD