Provider Demographics
NPI:1508851395
Name:HUBBARD, BRIDGETTE ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRIDGETTE
Middle Name:ANN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1513
Mailing Address - Country:US
Mailing Address - Phone:301-774-7170
Mailing Address - Fax:301-774-6676
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 207
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-774-7170
Practice Address - Fax:301-774-6676
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002018363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP07258Medicare UPIN
MD016541C95Medicare ID - Type Unspecified