Healthcare Provider Details

I. General information

NPI: 1689650244
Provider Name (Legal Business Name): JOHN CHRISTOPHER HUBBARD PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 BALTIMORE NATIONAL PIKE
CATONSVILLE MD
21228-3910
US

IV. Provider business mailing address

6323 EARLY GLOW CT
COLUMBIA MD
21045-4403
US

V. Phone/Fax

Practice location:
  • Phone: 443-514-1361
  • Fax:
Mailing address:
  • Phone: 410-381-1790
  • Fax: 410-381-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC002131
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: