Healthcare Provider Details

I. General information

NPI: 1689917866
Provider Name (Legal Business Name): TIMOTHY HUBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAZARD AVE STE 100
ENFIELD CT
06082-5447
US

IV. Provider business mailing address

1260 SILAS DEANE HWY STE 104
WETHERSFIELD CT
06109-4363
US

V. Phone/Fax

Practice location:
  • Phone: 860-289-3375
  • Fax:
Mailing address:
  • Phone: 860-289-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number71580
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number71580
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: