Healthcare Provider Details

I. General information

NPI: 1720396591
Provider Name (Legal Business Name): DANA L. RUBIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA RICHARDSON

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-2170
US

IV. Provider business mailing address

100 N ACADEMY AVE CREDENTIALS DEPT
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6363
  • Fax: 570-214-9208
Mailing address:
  • Phone: 570-271-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054536
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: