Healthcare Provider Details

I. General information

NPI: 1982629325
Provider Name (Legal Business Name): GERALDINE RUBIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 COURT ST DARTMOUTH HITCHCOCK - PEDIATRICS
KEENE NH
03431-1719
US

IV. Provider business mailing address

590 COURT ST DARTMOUTH HITCHCOCK - PEDIATRICS
KEENE NH
03431-1719
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5454
  • Fax:
Mailing address:
  • Phone: 603-354-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number10373
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0RE4881
Identifier TypeMEDICAID
Identifier StateVT
Identifier Issuer
# 2
Identifier3075074
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: