Provider Demographics
NPI:1235113317
Name:RUBIN, BRUCE KALMAN (MD, MENGR, MBA)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:KALMAN
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD, MENGR, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 780125
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0125
Mailing Address - Country:US
Mailing Address - Phone:804-922-4844
Mailing Address - Fax:
Practice Address - Street 1:1000 E BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1930
Practice Address - Country:US
Practice Address - Phone:804-828-2467
Practice Address - Fax:804-828-9439
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97015762080P0214X
VA01012461242080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891093TMedicaid
SCQ0157CMedicaid
VA6729738Medicaid
7556338OtherAETNA
1093TOtherBCBS
17762OtherPARTNERS
76111OtherMEDCOST
WV220407000Medicaid
370020986OtherRR MEDICARE
76111OtherMEDCOST
WV220407000Medicaid