Provider Demographics
NPI:1407852304
Name:HUBERTY, CHAD R (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:HUBERTY
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:PO BOX 3439
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-0439
Mailing Address - Country:US
Mailing Address - Phone:843-839-4447
Mailing Address - Fax:843-399-0123
Practice Address - Street 1:945 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4610
Practice Address - Country:US
Practice Address - Phone:843-497-5929
Practice Address - Fax:843-839-6375
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC266401Medicaid
SC266401Medicaid
SCAA02164639Medicare PIN
SC266401Medicaid
SCH93221Medicare UPIN