Provider Demographics
NPI:1194780890
Name:RUBENFELD, IRA GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:GEORGE
Last Name:RUBENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-955-9294
Mailing Address - Fax:215-955-0962
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-955-9294
Practice Address - Fax:215-955-0962
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025243E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41262Medicare UPIN
PA404687Medicare ID - Type Unspecified