Provider Demographics
NPI:1124154323
Name:QUERUBIN, ROEL NOLIDO (MD)
Entity type:Individual
Prefix:DR
First Name:ROEL
Middle Name:NOLIDO
Last Name:QUERUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 NORTH AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060
Mailing Address - Country:US
Mailing Address - Phone:770-560-7166
Mailing Address - Fax:770-727-2121
Practice Address - Street 1:MARIETTA RHEUMATOLOGY ASSOCIATES
Practice Address - Street 2:670 NORTH AVENUE SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-560-7166
Practice Address - Fax:770-727-2121
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043112207RR0500X
GA43112207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA690710060AMedicaid
GAGRP6671Medicare ID - Type UnspecifiedMEDICARE NUMBER
GA66BBBGTMedicare ID - Type UnspecifiedCARRIER PROVIDER NUMBER
GA690710060AMedicaid