Provider Demographics
NPI:1942375225
Name:RUBIN, CLIFFORD B (DO)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:B
Last Name:RUBIN
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 1:39 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:SO PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-761-0650
Mailing Address - Fax:207-761-8198
Practice Address - Street 1:2 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6078
Practice Address - Country:US
Practice Address - Phone:207-303-3300
Practice Address - Fax:207-250-2144
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2010208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432822899Medicaid
NH30226382Medicaid
ME000640201Medicare PIN
NH30226382Medicaid
MEP00645825Medicare PIN