MEDICARE: BRUCE E 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
1	2085R0202X	Diagnostic Radiology Physician	D0008649	MD

General Provider Information

NPI Number	:	1942290440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE E RUBIN MD

Provider Business Mailing Address
First Line	:	1201 SEVEN LOCKS RD
Second Line	:	SUITE 200
City	:	ROCKVILLE
State	:	MD
Zip	:	20854-2931
Country	:	US
Telephone Number	:	301-652-5771
Fax Number	:	301-652-6332

Provider Business Practice Location Address
First Line	:	7600 CARROLL AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6367
Country	:	US
Telephone Number	:	301-891-5106
Fax Number	:	301-891-5383

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	07/08/2007

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