Healthcare Provider Details

I. General information

NPI: 1003873126
Provider Name (Legal Business Name): MITCHELL HOWARD RUBENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CYPRESS ST
BROOKLINE MA
02445-6002
US

IV. Provider business mailing address

221 LONGWOOD AVENUE BRIGHAM AND WOMEN'S HOSPITAL DEPARTMENT OF DERMATOLOGY
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 857-307-0896
  • Fax:
Mailing address:
  • Phone: 617-732-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number42710
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: