Provider Demographics
NPI:1336122480
Name:GUBB, GEOFFREY W (MD)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:W
Last Name:GUBB
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:PO BOX 274
Mailing Address - Street 2:15249 ARTHUR'S COURT
Mailing Address - City:BELLE HAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:23306-0274
Mailing Address - Country:US
Mailing Address - Phone:757-414-0595
Mailing Address - Fax:757-414-0596
Practice Address - Street 1:15249 ARTHUR'S COURT
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-414-0595
Practice Address - Fax:757-414-0596
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA018800OtherANTHEM BCBS
VA7610408Medicaid
VA018800OtherANTHEM BCBS