Provider Demographics
NPI:1528234432
Name:RUBERU, MONIQUE SARANA (MD)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:SARANA
Last Name:RUBERU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12265 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1201
Mailing Address - Country:US
Mailing Address - Phone:215-856-1010
Mailing Address - Fax:215-698-3730
Practice Address - Street 1:727 WELSH ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-939-4251
Practice Address - Fax:855-385-3043
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD434267207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130556Medicare PIN