Provider Demographics
NPI:1073692893
Name:THOMAS J. HUBBARD, M.D., INC
Entity Type:Organization
Organization Name:THOMAS J. HUBBARD, M.D., INC
Other - Org Name:HUBBARD PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-687-1900
Mailing Address - Street 1:329 PHILLIP AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4380
Mailing Address - Country:US
Mailing Address - Phone:757-687-1900
Mailing Address - Fax:757-687-1895
Practice Address - Street 1:329 PHILLIP AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4380
Practice Address - Country:US
Practice Address - Phone:757-687-1900
Practice Address - Fax:757-687-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048101208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA240000236OtherMEDICARE BEFORE 5/21/08
VA440392OtherBCBS
VA240000236OtherMEDICARE BEFORE 5/21/08
VAD91164Medicare UPIN