Provider Demographics
NPI:1558941070
Name:HUBACH, AMELIA R (DO)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:R
Last Name:HUBACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 WHIP O WILL LN
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:VA
Mailing Address - Zip Code:24122-2744
Mailing Address - Country:US
Mailing Address - Phone:540-588-6889
Mailing Address - Fax:
Practice Address - Street 1:10510 JEFFERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3102
Practice Address - Country:US
Practice Address - Phone:540-588-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program