Provider Demographics
NPI:1336437094
Name:HUBERT, INNA Y (PA-C)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:Y
Last Name:HUBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-595-2700
Mailing Address - Fax:774-221-5136
Practice Address - Street 1:366 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4647
Practice Address - Country:US
Practice Address - Phone:508-595-2700
Practice Address - Fax:774-221-5136
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4210363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical