Basic Information
| Provider Information | |||||||||
| NPI: | 1962543280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBINO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18563 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276198563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197821806 | ||||||||
| FaxNumber: | 9197821669 | ||||||||
| Practice Location | |||||||||
| Address1: | 3521 HAWORTH DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197821806 | ||||||||
| FaxNumber: | 9197824756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 01/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 28689 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0197680 | 01 | CIGNA | OTHER | 30160 | 01 | MEDCOST | OTHER | 8973823 | 05 | NC | MEDICAID | 110167665 | 01 | RAILROAD MEDICARE | OTHER | 0452683 | 01 | UNITED HEALTHCARE | OTHER | 73823 | 01 | NC | BCBS | OTHER |