Provider Demographics
NPI:1730174392
Name:LUBENS, RICHARD M (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:LUBENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 PEARL ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2864
Mailing Address - Country:US
Mailing Address - Phone:508-897-6090
Mailing Address - Fax:508-580-0288
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2864
Practice Address - Country:US
Practice Address - Phone:508-897-6090
Practice Address - Fax:508-580-0288
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA52879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6177964Medicaid
A56987Medicare UPIN
MA6177964Medicaid