1528069226 NPI number — KANAN H HUDHUD MD

Table of content: KANAN H HUDHUD MD (NPI 1528069226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528069226 NPI number — KANAN H HUDHUD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUDHUD
Provider First Name:
KANAN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528069226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46B THOMAS JOHNSON DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-695-6777
Provider Business Mailing Address Fax Number:
601-695-4852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46B THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-695-6777
Provider Business Practice Location Address Fax Number:
601-695-4852
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  20263 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: D41866 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01960001 . This is a "CAREFIRST FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0081294000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75884400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4320060 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3810004318 . This is a "CLIA NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 522074387 . This is a "TAX ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52567805 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3601024 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 452203 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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