Provider Demographics
NPI:1053370536
Name:TUDOR, GENE GUY (MD)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:GUY
Last Name:TUDOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:110 HOSPITAL ROAD, SUITE 204
Mailing Address - Street 2:CALVERT OTOLARYNGOLOGY
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-414-7288
Mailing Address - Fax:410-414-7102
Practice Address - Street 1:110 HOSPITAL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4019
Practice Address - Country:US
Practice Address - Phone:410-414-7288
Practice Address - Fax:410-414-7102
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501133207Y00000X
MDD0066926207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC83936OtherBCBS
NC8983936Medicaid
NC9501133OtherSTATE LICENSE
MDD0066926OtherMD STATE LICENSE
MDD0066926OtherMD STATE LICENSE
NC83936OtherBCBS
NC9501133OtherSTATE LICENSE