Provider Demographics
NPI:1700942620
Name:HUBBUCH, JEANNE T (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:T
Last Name:HUBBUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 WALNUT ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1948
Mailing Address - Country:US
Mailing Address - Phone:617-965-7770
Mailing Address - Fax:
Practice Address - Street 1:288 WALNUT ST
Practice Address - Street 2:SUITE 420
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1948
Practice Address - Country:US
Practice Address - Phone:617-965-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine