=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073692893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS J. HUBBARD, M.D., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 11/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 329 PHILLIP AVE
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23454-4380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-687-1900
-----------------------------------------------------
Fax | 757-687-1895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 329 PHILLIP AVE
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23454-4380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-687-1900
-----------------------------------------------------
Fax | 757-687-1895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS J HUBBARD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 757-687-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 0101048101
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------