Provider Demographics
NPI:1710978846
Name:HOURDEQUIN, KATHRYN CUNNINGHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:CUNNINGHAM
Last Name:HOURDEQUIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:EVE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 MEDICAL CENTER DRIVE
Mailing Address - Street 2:DHMC/ NORRIS COTTON CANCER CENTER
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756
Mailing Address - Country:US
Mailing Address - Phone:603-650-9474
Mailing Address - Fax:603-653-0610
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:DHMC/ NORRIS COTTON CANCER CENTER
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756
Practice Address - Country:US
Practice Address - Phone:603-650-9474
Practice Address - Fax:603-653-0610
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15797207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012629Medicaid
NH3077666Medicaid
NH3077666Medicaid
NH002936301Medicare PIN
H89834Medicare UPIN
NH002936302Medicare PIN