=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710097050
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID N RUBIN MD FACC FASE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 09/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6847 N CHESTNUT ST SUITE 100
-----------------------------------------------------
City | RAVENNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44266-3929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-297-6110
-----------------------------------------------------
Fax | 330-296-0592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 168 E MARKET ST PO BOX 3542
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44308-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-996-0347
-----------------------------------------------------
Fax | 330-996-0359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 35067341
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------