Provider Demographics
NPI:1518957554
Name:LUBESKI, THOMAS HAROLD (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HAROLD
Last Name:LUBESKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 OLD OCEAN CITY BLVD
Mailing Address - Street 2:BUILDING ONE
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1288
Mailing Address - Country:US
Mailing Address - Phone:410-629-6863
Mailing Address - Fax:410-629-6869
Practice Address - Street 1:503 DUTCHMANS LN # A
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4334
Practice Address - Country:US
Practice Address - Phone:410-820-6500
Practice Address - Fax:410-820-6501
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0063448208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408416100Medicaid
MDE94862Medicare UPIN
MDKP95M517Medicare ID - Type Unspecified