Provider Demographics
NPI:1326142845
Name:HUBICKI, JOSEPH M (PAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:HUBICKI
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WYMAN PARK DRIVE
Mailing Address - Street 2:SUITE 359A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:410-338-3016
Mailing Address - Fax:410-338-3420
Practice Address - Street 1:4924 CAMPBELL BOULEVARD
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:443-442-2300
Practice Address - Fax:443-442-2360
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC00591363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
A385Medicare ID - Type Unspecified
D78068Medicare UPIN