Healthcare Provider Details

I. General information

NPI: 1992760847
Provider Name (Legal Business Name): ERIC J RUBIN MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM AND WOMENS HOSPITAL DIVISION OF INFECTIOUS DISE
BOSTON MA
02115
US

IV. Provider business mailing address

111 CYPRESS ST
BROOKLINE MA
02445-6002
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8881
  • Fax:
Mailing address:
  • Phone: 857-307-0896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number76192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: