MEDICARE: MRS. DENA C RUBIN P.A.

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
1	363AM0700X	Medical Physician Assistant	25MP00367600	NJ
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1447627377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENA C RUBIN P.A.

Provider Business Mailing Address
First Line	:	2219 YORK RD STE 102
Second Line	:
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-3140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2219 YORK RD STE 102
Second Line	:
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-3140
Country	:	US
Telephone Number	:	410-453-0002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2015
Last Update Date	:	10/10/2021

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