Provider Demographics
NPI:1699265280
Name:RUBERG, JOHN FOSTER (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FOSTER
Last Name:RUBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5733
Mailing Address - Country:US
Mailing Address - Phone:304-280-6053
Mailing Address - Fax:
Practice Address - Street 1:400 NORTH JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901
Practice Address - Country:US
Practice Address - Phone:304-645-3220
Practice Address - Fax:304-647-1273
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3480208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice