Healthcare Provider Details

I. General information

NPI: 1528069226
Provider Name (Legal Business Name): KANAN H HUDHUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S VAN BUREN RD
EDEN NC
27288-5019
US

IV. Provider business mailing address

46B THOMAS JOHNSON DR SUITE 200
FREDERICK MD
21702-4300
US

V. Phone/Fax

Practice location:
  • Phone: 336-623-9713
  • Fax: 336-623-1031
Mailing address:
  • Phone: 301-695-6777
  • Fax: 601-695-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01097013A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number20263
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD41866
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: