Healthcare Provider Details

I. General information

NPI: 1073798104
Provider Name (Legal Business Name): THOMAS J HUBBARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date: 06/06/2025
Reactivation Date: 10/24/2025

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:
Title or Position:
Credential:
Phone: