MEDICARE: THOMAS J. HUBBARD, M.D., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	0101048101	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	240000236	OTHER	VA	MEDICARE BEFORE 5/21/08

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	440392	OTHER	VA	BCBS

General Provider Information

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

Provider Business Mailing Address
First Line	:	329 PHILLIP AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4380
Country	:	US
Telephone Number	:	757-687-1900
Fax Number	:	757-687-1895

Provider Business Practice Location Address
First Line	:	329 PHILLIP AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4380
Country	:	US
Telephone Number	:	757-687-1900
Fax Number	:	757-687-1895

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS J HUBBARD
Credential	:	MD
Telephone Number	:	757-687-1900

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	11/03/2008

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