Provider Demographics
NPI:1821091331
Name:HUBACH, EDWARD A (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:HUBACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8999
Mailing Address - Fax:937-297-4852
Practice Address - Street 1:6255 CHAMBERSBURG ROAD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424
Practice Address - Country:US
Practice Address - Phone:937-233-7141
Practice Address - Fax:937-233-1956
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002371H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH220226705OtherDEPT. OF LABOR WC
OH0279087Medicaid
OH080191719OtherRAILROAD MEDICARE
OHD0237103OtherHUMANA/CHOICECARE
OH635756OtherAETNA
OH0120089OtherUNITED HEALTHCARE
OH34002371OtherMEDICAL LICENSE
OH421534506094OtherCARESOURCE
OH000000227899OtherANTHEM
OH421534506094OtherCARESOURCE
OH0279087Medicaid
OH421534506094OtherCARESOURCE
OH0279087Medicaid