Healthcare Provider Details

I. General information

NPI: 1003871971
Provider Name (Legal Business Name): MARK I RUBINSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD SUITE 300
FAIRFAX VA
22031-5207
US

IV. Provider business mailing address

8316 ARLINGTON BLVD SUITE 300
FAIRFAX VA
22031-5207
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-7600
  • Fax: 703-560-3808
Mailing address:
  • Phone: 703-573-7600
  • Fax: 703-560-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number010143630
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101043630
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number0101043630
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number0101043630
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: