Basic Information
| Provider Information | |||||||||
| NPI: | 1790740207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBINO | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 FAIRFAX AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 11/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101237646 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 17907040207 | 05 | VA | MEDICAID | -002 / -003 | 01 | VA | TRICARE/CHAMPUS | OTHER | 08108 | 01 | NC | BC/BS | OTHER | 4138999 | 01 | CIGNA | OTHER | 73368 | 01 | VA | SENTARA/OPTIMA | OTHER | PAR | 01 | VA | VA HEALTH NETWORK | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | 2173441 | 01 | VA | MAMSI | OTHER | 5908108 | 05 | NC | MEDICAID | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 309045 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | VA PREMIER HEALTH | OTHER | PAR | 01 | VA | AETNA | OTHER |