Healthcare Provider Details

I. General information

NPI: 1174552657
Provider Name (Legal Business Name): THOMAS PARK HUBBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/05/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W CENTRAL AVE
DELAWARE OH
43015-1421
US

IV. Provider business mailing address

7450 HOSPITAL DR STE 4500
DUBLIN OH
43016-9642
US

V. Phone/Fax

Practice location:
  • Phone: 740-363-1904
  • Fax: 740-363-5288
Mailing address:
  • Phone: 614-788-0588
  • Fax: 614-788-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.042551
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: