Provider Demographics
NPI:1760416309
Name:STUBBE, HERMAN G (MD)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:G
Last Name:STUBBE
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 1:4376 GERMANNA HWY
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508
Mailing Address - Country:US
Mailing Address - Phone:540-972-7798
Mailing Address - Fax:
Practice Address - Street 1:4376 GERMANNA HWY
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508
Practice Address - Country:US
Practice Address - Phone:540-972-7798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5624312Medicaid
VAE09027Medicare UPIN
VA080005767Medicare ID - Type Unspecified