Provider Demographics
NPI:1528069226
Name:HUDHUD, KANAN H (MD)
Entity type:Individual
Prefix:
First Name:KANAN
Middle Name:H
Last Name:HUDHUD
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 1:46B THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4300
Mailing Address - Country:US
Mailing Address - Phone:301-695-6777
Mailing Address - Fax:601-695-4852
Practice Address - Street 1:516 S VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5019
Practice Address - Country:US
Practice Address - Phone:336-623-9713
Practice Address - Fax:336-623-1031
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20263207RX0202X
MDD41866207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD01960001OtherCAREFIRST FEDERAL
MD3601024OtherUNITED HEALTHCARE
MD52567805OtherCAREFIRST
WV0081294000Medicaid
MD75884400Medicaid
WV3810004318OtherCLIA NUMBER
MD4320060OtherAETNA
MD522074387OtherTAX ID
MD452203OtherMAMSI
MD52567805OtherCAREFIRST
MD3601024OtherUNITED HEALTHCARE
F31727Medicare UPIN