Basic Information
Provider Information | |||||||||
NPI: | 1417343286 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BAKSH | ||||||||
FirstName: | RUBINA | ||||||||
MiddleName: | BATOOL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | AHMAD | ||||||||
OtherFirstName: | RUBINA | ||||||||
OtherMiddleName: | BATOOL | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 300 E MCBEE AVE FL 4 | ||||||||
Address2: |   | ||||||||
City: | GREENVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 296012842 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8645228603 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 807 N MAIN ST | ||||||||
Address2: |   | ||||||||
City: | TRAVELERS REST | ||||||||
State: | SC | ||||||||
PostalCode: | 296901551 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8644559261 | ||||||||
FaxNumber: | 8644559264 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/08/2015 | ||||||||
LastUpdateDate: | 04/11/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 51539 | SC | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 515393 | 05 | SC |   | MEDICAID | SCE608 | 01 | SC | MEDICARE | OTHER |