Healthcare Provider Details

I. General information

NPI: 1649257031
Provider Name (Legal Business Name): SCOTT D RUBIN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MAIN ST STE A
SPRINGFIELD MA
01107-1113
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-9560
  • Fax: 413-794-5884
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2012
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: