Provider Demographics
NPI:1750429320
Name:RUBIN, SUZANNE EDYTHE (CPNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:EDYTHE
Last Name:RUBIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 MEADOWSWEET RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6383
Mailing Address - Country:US
Mailing Address - Phone:410-415-5923
Mailing Address - Fax:
Practice Address - Street 1:8521 MEADOWSWEET RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6383
Practice Address - Country:US
Practice Address - Phone:410-415-5923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR121818363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics