Individual
KANAN H HUDHUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
516 S VAN BUREN RD, EDEN, NC 27288-5019
(336) 623-9713
(336) 623-1031
Mailing address
46B THOMAS JOHNSON DR, SUITE 200, FREDERICK, MD 21702-4300
(301) 695-6777
(601) 695-4852
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
D41866
MD
207RX0202X
Medical Oncology Physician
01097013A
IN
207RX0202X
Medical Oncology Physician
20263
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0081294000
—
WV
01
—
01960001
CAREFIRST FEDERAL
MD
01
—
3601024
UNITED HEALTHCARE
MD
01
—
3810004318
CLIA NUMBER
WV
01
—
4320060
AETNA
MD
01
—
452203
MAMSI
MD
01
—
522074387
TAX ID
MD
01
—
52567805
CAREFIRST
MD
05
—
75884400
—
MD
Enumeration date
08/03/2005
Last updated
08/11/2025
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