Provider Demographics
NPI:1992814891
Name:BRUBAKER, BETH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:CB 7085
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7085
Mailing Address - Country:US
Mailing Address - Phone:984-974-1931
Mailing Address - Fax:984-974-2216
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:CB 7085
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7085
Practice Address - Country:US
Practice Address - Phone:984-974-1931
Practice Address - Fax:984-974-2216
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401032207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902277Medicaid
NC2047843Medicare ID - Type Unspecified
NC5902277Medicaid