Individual
DR. ILYA RUBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 PROVIDENCE RD, SUITE 101, CHARLOTTE, NC 28207-1437
(704) 749-5800
(704) 749-5819
Mailing address
200 PROVIDENCE RD, SUITE 101, CHARLOTTE, NC 28207-1437
(704) 749-5800
(704) 749-5819
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2007-00173
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5907037
—
NC
05
—
N0017D
—
SC
Enumeration date
06/05/2006
Last updated
02/20/2012
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