Provider Demographics
NPI:1376515775
Name:HUBACH, KURT (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:
Last Name:HUBACH
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 1:867 BURKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-3201
Mailing Address - Country:US
Mailing Address - Phone:540-589-4730
Mailing Address - Fax:
Practice Address - Street 1:867 BURKS HILL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3201
Practice Address - Country:US
Practice Address - Phone:540-589-4730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-044001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE48443Medicare UPIN
VA00X348B01Medicare PIN