Provider Demographics
NPI:1295828754
Name:HUBBARD, DEE L (MD)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:L
Last Name:HUBBARD
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 1:8110 MAPLE LAWN BLVD BLDG STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2693
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:844 WASHINGTON RD STE 302
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6664
Practice Address - Country:US
Practice Address - Phone:410-848-6294
Practice Address - Fax:410-848-3009
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027092207V00000X
MI4301043663207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187180YBDBMedicare PIN
MI1605210361OtherBC/BS
MIOE26024009Medicare ID - Type Unspecified
MI4628218Medicaid
MD187180YBDBMedicare PIN