Healthcare Provider Details

I. General information

NPI: 1518957554
Provider Name (Legal Business Name): THOMAS HAROLD LUBESKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 DUTCHMANS LN # A
EASTON MD
21601-4334
US

IV. Provider business mailing address

10026 OLD OCEAN CITY BLVD BUILDING ONE
BERLIN MD
21811-1288
US

V. Phone/Fax

Practice location:
  • Phone: 410-820-6500
  • Fax: 410-820-6501
Mailing address:
  • Phone: 410-629-6863
  • Fax: 410-629-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH0063448
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: