Healthcare Provider Details

I. General information

NPI: 1144433590
Provider Name (Legal Business Name): RUBINA DOLVANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N. WASHINGTON STREET SUITE 100
FALLS CHURCH VA
22046-3303
US

IV. Provider business mailing address

407 N. WASHINGTON STREET SUITE 100
FALLS CHURCH VA
22046-3303
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-5919
  • Fax: 703-241-1863
Mailing address:
  • Phone: 703-237-5919
  • Fax: 703-241-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD434867
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: