Healthcare Provider Details

I. General information

NPI: 1073692893
Provider Name (Legal Business Name): THOMAS J. HUBBARD, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 PHILLIP AVE
VIRGINIA BEACH VA
23454-4380
US

IV. Provider business mailing address

329 PHILLIP AVE
VIRGINIA BEACH VA
23454-4380
US

V. Phone/Fax

Practice location:
  • Phone: 757-687-1900
  • Fax: 757-687-1895
Mailing address:
  • Phone: 757-687-1900
  • Fax: 757-687-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101048101
License Number StateVA

VIII. Authorized Official

Name: DR. THOMAS J HUBBARD
Title or Position: OWNER
Credential: MD
Phone: 757-687-1900