Provider Demographics
NPI:1669860128
Name:MADHAVI HUBBLY MD
Entity Type:Organization
Organization Name:MADHAVI HUBBLY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-528-4134
Mailing Address - Street 1:12116 DARNESTOWN RD STE L5
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2227
Mailing Address - Country:US
Mailing Address - Phone:301-528-4134
Mailing Address - Fax:
Practice Address - Street 1:12116 DARNESTOWN RD STE L5
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2227
Practice Address - Country:US
Practice Address - Phone:301-528-4134
Practice Address - Fax:301-569-7358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62562207R00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty