Healthcare Provider Details

I. General information

NPI: 1801113386
Provider Name (Legal Business Name): GERARD RUBIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E CHESTNUT ST STE 310
AUGUSTA ME
04330-5717
US

IV. Provider business mailing address

6 E CHESTNUT ST STE 310
AUGUSTA ME
04330-5717
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-2977
  • Fax: 207-621-1612
Mailing address:
  • Phone: 207-623-2977
  • Fax: 207-621-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO2499
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: