Provider Demographics
NPI:1588633267
Name:HUBBARD, THOMAS MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:HUBBARD
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 1:100 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005
Mailing Address - Country:US
Mailing Address - Phone:804-798-8307
Mailing Address - Fax:804-798-4204
Practice Address - Street 1:100 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005
Practice Address - Country:US
Practice Address - Phone:804-798-8307
Practice Address - Fax:804-798-4204
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5634148Medicaid
E12231Medicare UPIN
VA5634148Medicaid
VA080006610Medicare PIN
080006610Medicare PIN