Provider Demographics
NPI:1346766680
Name:HUBER, JEFFREY M (DOM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:HUBER
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 SEARLES RD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-2119
Mailing Address - Country:US
Mailing Address - Phone:410-905-9449
Mailing Address - Fax:
Practice Address - Street 1:2000 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1595
Practice Address - Country:US
Practice Address - Phone:410-878-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01946171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist