Provider Demographics
NPI:1043291917
Name:HUBBELL, SUSAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:HUBBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 W MARKET ST
Mailing Address - Street 2:STE 1
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2738
Mailing Address - Country:US
Mailing Address - Phone:419-228-5434
Mailing Address - Fax:419-228-4620
Practice Address - Street 1:939 W MARKET ST
Practice Address - Street 2:STE 1
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2738
Practice Address - Country:US
Practice Address - Phone:419-228-5434
Practice Address - Fax:419-228-4620
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-1078208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
250001154OtherRAILROAD MEDICARE
000000120843OtherBLUE SHIELD
OH0432277Medicaid
OH341526576 00OtherWC
A79677Medicare UPIN
HU0483564Medicare ID - Type Unspecified