Healthcare Provider Details

I. General information

NPI: 1114944758
Provider Name (Legal Business Name): FRED H RUBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CENTRE AVENUE STE 405
PITTSBURGH PA
15232
US

IV. Provider business mailing address

5230 CENTRE AVENUE #341 SCHOOL OF NURSING BUILDING UPMC SHADYSIDE HOSPITAL
PITTSBURGH PA
15232
US

V. Phone/Fax

Practice location:
  • Phone: 412-623-2700
  • Fax: 412-623-1235
Mailing address:
  • Phone: 412-623-2518
  • Fax: 412-623-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD019241E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: