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NPI Code Detail

MEDICARE: JONATHAN RUBIN MD

MEDICARE: JONATHAN RUBIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMD027340EPA
22085R0204XVascular & Interventional Radiology PhysicianMD027340EPA

General Provider Information

NPI Number : 1154302800
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN RUBIN MD
Provider Business Mailing Address
First Line : 2450 W HUNTING PARK AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19129-1302
Country : US
Telephone Number : 215-707-7237
Fax Number : 215-707-9389
Provider Business Practice Location Address
First Line : 3401 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5189
Country : US
Telephone Number : 215-707-7237
Fax Number : 215-707-9389
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 10/10/2019

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