Provider Demographics
NPI:1174552657
Name:HUBBELL, THOMAS PARK (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PARK
Last Name:HUBBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 HOSPITAL DR
Mailing Address - Street 2:STE 4500
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9642
Mailing Address - Country:US
Mailing Address - Phone:614-788-0588
Mailing Address - Fax:614-788-0587
Practice Address - Street 1:550 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1421
Practice Address - Country:US
Practice Address - Phone:740-363-1904
Practice Address - Fax:740-363-5288
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.042551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0374090Medicaid
OH000000019610OtherANTHEM BC/BS
A77846Medicare UPIN
OHHU0454202Medicare ID - Type Unspecified