Healthcare Provider Details

I. General information

NPI: 1588649529
Provider Name (Legal Business Name): NINO C RUBINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 CLINGAN RD SUITE C
POLAND OH
44514-2196
US

IV. Provider business mailing address

6615 CLINGAN RD SUITE C
POLAND OH
44514-2196
US

V. Phone/Fax

Practice location:
  • Phone: 330-757-7888
  • Fax: 330-757-4912
Mailing address:
  • Phone: 330-757-7888
  • Fax: 330-757-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35086115
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35086115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: