MEDICARE: DR. GENE GUY TUDOR MD

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	207Y00000X	Otolaryngology Physician	9501133	NC
2	207Y00000X	Otolaryngology Physician	D0066926	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83936	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9501133	OTHER	NC	STATE LICENSE
4	D0066926	OTHER	MD	MD STATE LICENSE

General Provider Information

NPI Number	:	1053370536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENE GUY TUDOR MD

Provider Business Mailing Address
First Line	:	110 HOSPITAL ROAD, SUITE 204
Second Line	:	CALVERT OTOLARYNGOLOGY
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678
Country	:	US
Telephone Number	:	410-414-7288
Fax Number	:	410-414-7102

Provider Business Practice Location Address
First Line	:	110 HOSPITAL RD
Second Line	:	SUITE 204
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4019
Country	:	US
Telephone Number	:	410-414-7288
Fax Number	:	410-414-7102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. GENE GUY TUDOR MD” Practice Location

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