Provider Demographics
NPI:1073798104
Name:HUBBARD, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 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
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048101208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA440392OtherBLUE CROSS BLUE SHIELD
VA240000236OtherMEDICARE BEFORE 5/21/08
VAD91164Medicare UPIN
VAGC1061 SC0001043Medicare PIN