Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD417839 | PA |
N | 2081P2900X | Pain Medicine | MD417836 | PA |
NPI | 1669481578 |
---|---|
Provider Name | Daniel Theodore Rubino |
First Address | Devon, PA 19333 |
Second Address | Devon, PA 19333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 07/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H60300 | (02) | PA |